Impact of personalized selection of surgical intervention extent on early postoperative outcomes and quality of life in patients with papillary thyroid microcarcinoma
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16645Keywords:
thyroid neoplasms, precision medicine, postoperative complications, immunohistochemistry, quality of life, risk assessment, thyroidectomyAbstract
The aim of the work: to assess the association between personalized selection of surgical intervention extent for papillary thyroid microcarcinoma with early postoperative complications and health-related quality of life.
Materials and Methods. A secondary analysis of a prospectively assembled comparative cohort of 110 patients treated in 2024–2026 was performed. In the control group (n=54), surgical extent was selected using standard clinical, ultrasonographic, and cytological criteria. In the study group (n=56), preoperative immunocytochemical assessment of cytokeratin 17, thyroid peroxidase, and S-cells was additionally incorporated into comprehensive risk stratification. Complications were graded according to the Clavien-Dindo classification. Quality of life was assessed with the SF-36 at 3 months after surgery in all 110 patients according to the actual procedure: hemithyroidectomy (n=52) or thyroidectomy (n=58).
Results. Hemithyroidectomy was more frequent in the study group than in the control group (60.7 % vs 33.3 %; p=0.004). The overall early complication rate was lower (30.4 % vs 50.0 %; OR=0.44; 95 % CI=0.20–0.95; p=0.036). Major complications (Clavien-Dindo III–IV) were numerically less frequent but did not reach statistical significance (1.8 % vs 9.3 %; p=0.110). After hemithyroidectomy, scores were higher for physical functioning (84.2±9.1 vs 72.5±10.4), role-physical functioning (81.5±10.3 vs 69.7±11.2), vitality (78.6±8.7 vs 67.4±9.5), and social functioning (86.3±7.5 vs 74.8±8.9); all eight SF-36 domains differed at p<0.001. The findings indicate more favorable short-term patient-oriented outcomes after less extensive surgery; however, because of the nonrandomized design, these differences should be interpreted as associations rather than causal effects.
Conclusions. Personalized selection of surgical extent was associated with more frequent hemithyroidectomy, a lower overall early complication rate, and better quality-of-life scores 3 months after organ-preserving surgery.
References
1. WHO Classification of Tumours Editorial Board. Endocrine and neuroendocrine tumours. 5th ed. Vol. 10. Lyon: International Agency for Research on Cancer; 2025.
2. Zhang J, Xu S. High aggressiveness of papillary thyroid cancer: from clinical evidence to regulatory cellular networks. Cell Death Discov. 2024; 10(1):378. DOI: 10.1038/s41420-024-02157-2. DOI: https://doi.org/10.1038/s41420-024-02157-2
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. Version 1.2025 [Internet]. Plymouth Meeting (PA): NCCN; 2025 [cited 2026 Aug 16]. Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1470.
4. Lim J, Lee HS, Heo JH, Song YS. Clinicopathological features and molecular signatures of lateral neck lymph node metastasis in papillary thyroid microcarcinoma. Endocrinol Metab (Seoul). 2024; 39(2):324-33. DOI: 10.3803/EnM.2023.1885. DOI: https://doi.org/10.3803/EnM.2023.1885
5. Ringel MD, Sosa JA, Baloch Z, et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025; 35(8):841-985. DOI: 10.1177/10507256251363120. DOI: https://doi.org/10.1177/10507256251363120
6. Hsiao V, Light TJ, Adil AA, et al. Complication rates of total thyroidectomy vs hemithyroidectomy for treatment of papillary thyroid microcarcinoma: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2022; 148(6):531-39. DOI: 10.1001/jamaoto.2022.0621. DOI: https://doi.org/10.1001/jamaoto.2022.0621
7. Zelinsʹka HV. Tsytokeratyn 17 ta tyreoyidna peroksydaza yak imunotsytokhimichni markery dlya peredoperatsiynoho prohnozuvannya rezystentnosti do radioyodu ta efektyvnosti radioyodterapiyi pry papilyarniy kartsynomi shchytopodibnoyi zalozy [Cytokeratin 17 and thyroid peroxidase as immunocytochemical markers for preoperative prediction of radioiodine resistance and effectiveness of radioiodine therapy in papillary thyroid carcinoma]. Onkolohiya – Oncology. 2019; 21(1):31-5. DOI: 10.32471/oncology. 2663-7928.t-21-3-2019-g.7376. Ukrainian.
8. Zelinsʹka HV. Tsytolohichne prohnozuvannya ahresyvnosti raku shchytopodibnoyi zalozy yak perspektyvnyy napryamok u klinichniy tyreoyidolohiyi [Cytological prediction of thyroid cancer aggressiveness as a promising direction in clinical thyroidology]. Endokrynolohiya – Endokrynologia. 2024; 29(4):363-71. DOI: 10.31793/1680-1466.2024.29-4.363. Ukrainian. DOI: https://doi.org/10.31793/1680-1466.2024.29-4.363
9. Li X, Cheng R. TPO as an indicator of lymph node metastasis and recurrence in papillary thyroid carcinoma. Sci Rep. 2023; 13:10848. DOI: 10.1038/s41598-023-37932-1. DOI: https://doi.org/10.1038/s41598-023-37932-1
10. Schumm MA, Shu ML, Hughes EG, Nikiforov YE, Nikiforova MN, Wald AI, et al. Prognostic value of preoperative molecular testing and implications for initial surgical management in thyroid nodules harboring suspected (Bethesda V) or known (Bethesda VI) papillary thyroid cancer. JAMA Otolaryngol Head Neck Surg. 2023; 149(8):735-42. DOI: 10.1001/jamaoto.2023.1494. DOI: https://doi.org/10.1001/jamaoto.2023.1494
11. Bach K, Ansari P, Ansari H, et al. Health-related quality of life in patients with low-risk differentiated thyroid cancer: a systematic review examining the extent of thyroidectomy. Thyroid. 2024; 34(1):14-25. DOI: 10.1089/thy.2023.0328. DOI: https://doi.org/10.1089/thy.2023.0328
12. Yaniv D, Vainer I, Amir I, et al. Quality of life following lobectomy versus total thyroidectomy is significantly related to hypothyroidism. J Surg Oncol. 2022; 126(4):640-48. DOI: 10.1 002/jso.26983. DOI: https://doi.org/10.1002/jso.26983
13. Chen W, Li J, Peng S, et al. Association of total thyroidectomy or thyroid lobectomy with the quality of life in patients with differentiated thyroid cancer with low to intermediate risk of recurrence. JAMA Surg. 2022; 157(3):200-09. DOI: 10.1001/jamasurg.2021.6442. DOI: https://doi.org/10.1001/jamasurg.2021.6442
14. Tronʹko MD, Zelinsʹka HV, Bozhok YuM, Kvachenyuk AM, Hulevatyy SV, Kulinichenko HM ta in. Tsytolohichni faktory prohnozu pislyaoperatsiynykh metastaziv ta radioyodrezystentnosti papilyarnoho raku shchytopodibnoyi zalozy [Cytological factors for prognosis of postoperative metastases and radioiodine resistance of papillary thyroid cancer]. Endokrynolohiya – Endokrynologia. 2021; 26(4):326-35. DOI: 10.31793/1680-1466.2021.26-4.326. Ukrainian. DOI: https://doi.org/10.31793/1680-1466.2021.26-4.326
15. Hoang JK, Middleton WD, Tessler FN. Update on ACR TI-RADS: successes, challenges, and future directions, from the AJR special series on radiology reporting and data systems. AJR Am J Roentgenol. 2021; 216(3):570-78. DOI: 10.2214/AJR.20.24608. DOI: https://doi.org/10.2214/AJR.20.24608
16. Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, Vander Laan PA. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2023; 33(9):1039-44. DOI: 10.1089/thy.2023.0141. DOI: https://doi.org/10.1089/thy.2023.0141
17. Abbassi F, Pfister M, Lucas KL, et al. Milestones in surgical complication reporting: Clavien-Dindo Classification 20 years and Comprehensive Complication Index 10 years. Ann Surg. 2024; 280(5):763-71. DOI: 10.1097/SLA.0000000000006471. DOI: https://doi.org/10.1097/SLA.0000000000006471
18. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human participants. JAMA. 2025; 333(1):71-4. DOI: 10.1001/jama.2024.21972. DOI: https://doi.org/10.1001/jama.2024.21972
19. Bi J, Zhang H. A meta-analysis of total thyroidectomy and lobectomy outcomes in papillary thyroid microcarcinoma. Medicine (Baltimore). 2023; 102(50):e36647. DOI: 10.1097/MD.0000000000036647. DOI: https://doi.org/10.1097/MD.0000000000036647
20. Landry V, Siciliani E, Henry M, Payne RJ. Health-related quality of life following total thyroidectomy and lobectomy for differentiated thyroid carcinoma: a systematic review. Curr Oncol. 2022; 29(7):4386-22. DOI: 10.3390/curroncol29070350. DOI: https://doi.org/10.3390/curroncol29070350
21. Van Dijk SPJ, Blanco MMK, McMullin JL, et al. Patient-reported outcomes across treatment strategies in papillary thyroid microcarcinoma: a meta-analysis. JAMA Otolaryngol Head Neck Surg. 2026; 152(2):154-62. DOI: 10.1001/jamaoto.2025.4670. DOI: https://doi.org/10.1001/jamaoto.2025.4670
22. Atallah K, Awny S, Abdelwahab K, et al. Morbidity patterns and long-term outcomes of central lymph node dissection in thyroid cancer patients. Sci Rep. 2025; 15:23527. DOI: 10.1038/s41598-025-08439-8. DOI: https://doi.org/10.1038/s41598-025-08439-8
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Юрій Скрипко, Олег Ткачук
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
