Papillary Thyroid Cancer After Hemithyroidectomy: Significance of Microscopic Margin Involvement

Background: Microscopic margin positivity after total thyroidectomy has been shown not to jeopardize the oncologic outcomes for papillary thyroid carcinoma (PTC). However, the prognostic effect of microscopic margin after hemithyroidectomy is under-investigated. This study aims to investigate the prognostic implication of microscopic margin on locoregional recurrence of PTC following hemithyroidectomy as the definite treatment.

Methods: Between 2000 and 2024, 148 patients with PTC were treated with hemithyroidectomy. Four cases were excluded because of N1b disease with ipsilateral neck dissection (n=3) and loss to follow-up (n=1). Thus, 144 patients with preoperative localized PTC were retrospectively evaluated. Reporting adhered to the STROBE standard.

Results: Negative margins were observed in 133 patients (92.4%), and positive margins in 11 patients (7.6%). The mean follow-up durations were comparable, 119.8 and 108.7 months respectively for patients with negative and positive margins (P=.273). Age, sex, tumor characteristics, TNM classification, American Thyroid Association risk stratification, and follow-up duration were similar between the 2 groups. Local recurrence developed in 0% of the margin-positive group and 0.8% of the margin-negative group, respectively. No patients died of PTC in this cohort.

Conclusion: Microscopic margin involvement after hemithyroidectomy is not an independent predictor of local recurrence. Completion thyroidectomy may not be necessary for selected cases if other adverse prognosticators are absent.

Cite this article as: Chow T, Wong BKC. Papillary thyroid cancer after hemithyroidectomy: Significance of microscopic margin involvement. Balkan ORL-HNS 2025;2(3):64-68.