Abstract
The rising incidence of differentiated thyroid cancer (DTC), particularly papillary thyroid carcinoma (PTC), has sparked interest in de-escalating surgical management to reduce morbidity while maintaining oncological safety. While total thyroidectomy remains the standard of care, hemithyroidectomy has emerged as a potential alternative for low- to moderate-risk PTC. This study evaluates the feasibility and oncological outcomes of hemithyroidectomy compared to total thyroidectomy in a tertiary care center in Northern India. This observational study included 214 patients diagnosed with PTC between 2010 and 2015. Patients were divided into two groups: 107 underwent hemithyroidectomy, and 107 underwent total thyroidectomy. The groups were matched for age, gender, tumor size, and ATA risk stratification. Primary outcomes included disease-free survival (DFS), structural recurrence, and all-cause mortality over 1, 5, and 10 years. Statistical analysis was performed to compare outcomes between the two groups. The mean age at diagnosis was 41.72 ± 5.2 years in the hemithyroidectomy group and 40.6 ± 5.2 years in the total thyroidectomy group (p = 0.47). Tumor size (1.67 ± 0.37cm vs. 1.78 ± 0.30, p = 0.073) and ATA risk stratification (low risk: 65 vs. 61, p = 0.57; intermediate risk: 42 vs. 46, p = 0.57) were comparable. Structural recurrence rates at 1, 5, and 10 years were similar between groups with no statistically significant difference (p = 0.166). The 5-year DFS rates were 95.00% (hemithyroidectomy) and 97.10% (total thyroidectomy), while the 10-year DFS rates were 93.45% and 96.26%, respectively. Hemithyroidectomy demonstrates comparable oncological safety to total thyroidectomy in low- to selected moderate-risk PTC, which include patients with microscopic extra thyroidal extension and microscopic capsular & vascular invasion, supporting its role as a conservative surgical option. Strict adherence to follow-up protocols is essential to detect and manage recurrence promptly. Careful patient selection and individualized treatment planning are critical to achieving optimal outcomes in the era of surgical de-escalation for thyroid cancer.