[Comparison of recurrence and complication by different thyroidectomy in the treatment of differentiated thyroid carcinoma as initial treatment: a meta-analysis]

To compare the total thyroidectomy or subtotal resection and gland lobe and isthmus lobectomy as initial treatment to TNM stage I and II differentiated thyroid cancer. The difference between recurrence rate and surgical complications were analysed.The literatures published between 1972-2012 were searched in Pubmed, Medline, Wanfang database, Chinese Biomedical Literature Database, Chinese scientific Journals database and China National Knowledge Infrastructure. According to the inclusion and deletion criteria, 17 articles were included to compare the postoperative recurrence and complications in randomized controlled or case-control studies, involving 13 articles in recurrence rate and 11 articles in complications.RevMan5.0 software package was used to perform meta-analysis.Thirteen articles involved with the recurrence rate, the total case number was 3511. Among these cases, 414 recurred, overall recurrence rate was 11.59%, of which, 150 recurred cases in total or subtotal resection group (experimental group), the recurrence rate was 6.51%; 264 recurred cases in gland lobe lobectomy plus isthmus group (control group), the recurrence rate was 21.83%. Comparing the two groups, the odds ratio (OR) and their 95% confidence interval (95%CI) was 0.26 [0.21,0.33], Z value was 11.33, P0.01, which showed that the recurrence rate in experimental group was significantly lower than that in control group.Eleven articles involved with the complications, the total case number was 2388, 166 cases had postoperative complications. The complication rate was 6.95%, of which, 109 cases in experimental group, the complication rate was 8.52%; 57 cases in control group, the complication rate was 5.15%. Compared with the two groups, OR values and their 95%CI was 3.63 [2.47, 5.33], Z was 6.58, P0.01, the experimental group had significantly higher incidence of complications.For I and II differentiated thyroid cancer, total thyroidectomy or subtotal resection may reduce the chance of recurrence, but the postoperative complications is higher; while gland lobe and isthmus lobectomy has lower postoperative complications, but may increase the risk of relapse.