Recurrence and postoperative quality of life after surgical resection of unilateral cT1-T3N1bM0 papillary thyroid carcinoma.

Background: Determining the optimal extent of surgery and improving postoperative quality of life for patients with papillary thyroid cancer has been an important challenge. Here, we evaluated postoperative quality of life after cT1-T3N1bM0 papillary thyroid carcinoma (PTC) to explore the optimal scope of surgical resection.

Methods: In this study, we investigated surgical outcomes in patients diagnosed with unilateral cT1-T3N1bM0 PTC, who were treated at Harbin Medical University Cancer Hospital from January 2008 to December 2018. To achieve this, we divided the patients into two distinct groups based on the extent of surgery they received: the non-total thyroidectomy group (group A) and the total thyroidectomy group (group B). To comprehensively evaluate the patients' well-being, we assessed their psychological status, disease recurrence rate, postoperative complications, and quality of life.

Results: A total of 362 patients diagnosed with thyroid cancer were included in this study, with group A (n=88) and group B (n=274) classified based on the extent of surgery received. Significant differences were observed between the two groups in terms of clinical and pathological characteristics, including age (χ²=10.962, P=0.001), sex (χ²=5.906, P=0.02), multifocal (χ²=5.515, P=0.02), contralateral glandular nodule (χ²=34.616, P<0.001), clinical Tumor, Node, Metastasis (TNM) stage (χ²=11.340, P=0.001), and complication rate (χ²=4.265, P=0.04). Notably, group B exhibited higher rates of postoperative complications, including temporary recurrent laryngeal nerve injury (χ²=4.630, P=0.03), and temporary hypocalcemia (χ²=3.954, P=0.047) compared to group A. However, after adjustment for propensity score matching (PSM), the recurrence rate was independent of the surgical extent in both groups. In contrast, tumour size (>1 cm) (χ²=4.497, P=0.03), extrathyroidal invasion (χ²=5.133, P=0.02) and pathological T stage (χ²=7.663, P=0.02) increased the risk of recurrence. Moreover, there was no significant difference in the Hospital Anxiety and Depression Scale (HADS) scores between two groups (χ²=1.266, P=0.53). Nevertheless, the postoperative quality of life, as well as the incidence of hoarseness (t=11.77, P<0.001), symptoms of calcium deficiency (t=8.13, P<0.001), and willingness to reduce medication (t=3.60, P<0.001) were significantly lower in group A than in group B.

Conclusions: In patients with PTC diagnosed as unilateral cT1-T3N1bM0 and a contralateral glandular nodule ≤2 cm, the preservation of the contralateral gland does not appear to have a significant impact on the rate of tumour recurrence in patients with tumour size (<1 cm), no extrathyroidal invasion, and pathological T stage (< T3). Instead, preserving gland potentially improves the prognosis, quality of life, and complication rates in these patients.