Total thyroidectomy versus limited thyroidectomy for isthmic papillary thyroid carcinoma: a systematic review and meta-analysis of oncologic outcomes and surgical morbidity.

BACKGROUND: The optimal surgery for isthmic papillary thyroid carcinoma (IPTC) remains controversial. This meta-analysis compared oncologic and complication outcomes between total (TT) and limited thyroidectomy (LT). METHODS: PubMed, Embase, and Web of Science were searched up to December 2025 for retrospective cohort studies comparing TT and LT for IPTC. Outcomes were recurrence and complications. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models. RESULTS: Eight studies comprising 1,285 patients (696 LT, 589 TT) were included. Recurrence rates were comparable (LT: 6.61% vs. TT: 4.07%; pooled RR = 1.40, 95% CI: 0.79-2.47, P = 0.25; I2 = 13%). LT significantly reduced overall complications (RR = 0.39, 95% CI: 0.30-0.50, P < 0.00001), including transient complications (RR = 0.39), parathyroid dysfunction (RR = 0.30), and hoarseness (RR = 0.44). CONCLUSION: In selected patients with isthmic papillary thyroid carcinoma, limited thyroidectomy may achieve similar short-term oncologic outcomes to total thyroidectomy while reducing complications, although the available evidence remains insufficient to establish oncologic equivalence. However, given methodological limitations, these findings are hypothesis-generating and require validation through prospective studies with standardized outcome definitions and extended follow-up.