{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:35:29Z","timestamp":1787236529036,"version":"build-2736575974"},"reference-count":23,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The optimal extent of surgery and the role of radioactive iodine (RAI) in patients with papillary thyroid carcinoma (PTC) with lateral neck metastasis (cN1b) remain controversial. We aimed to evaluate the oncologic outcomes of lobectomy with lateral neck dissection, total thyroidectomy with lateral neck dissection, and total thyroidectomy with lateral neck dissection followed by adjuvant RAI in patients with intermediate-risk cN1b PTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this multicenter retrospective cohort study, we included patients with cT1\u20133N1bM0 PTC who underwent thyroidectomy with therapeutic lateral neck dissection between 2010 and 2022. Recurrence-free survival (RFS) and disease-specific survival (DSS) were compared across three treatment groups using Kaplan\u2013Meier. Multivariable cox proportional hazards models were also used to identify independent risk factors for recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We included 593 patients (60.6% female; median age, 58.0 years) who had a median follow-up duration of 71.5 months. We observed no significant differences in RFS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.19) or DSS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.40) among the treatment groups of lobectomy, total thyroidectomy, and total thyroidectomy with RAI. Although the total thyroidectomy with RAI group showed a trend toward worse RFS, this was not statistically significant (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.19). In multivariable analysis, older age (hazard ratio [HR] 1.024 per year, confidence interval [CI] 1.007\u20131.041,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.006), larger primary tumor size (HR 1.026 per mm, CI 1.012\u20131.041,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), larger metastatic lymph node size (HR 1.020 per mm, CI 1.003\u20131.036,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.017), and extranodal extension (HR 1.741, CI 1.046\u20132.898,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.033) were independently associated with shorter RFS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>RAI may improve RFS in selected patients with extensive nodal disease, but its routine use in all cN1b PTC cases may be unnecessary. Lobectomy or total thyroidectomy without RAI could be appropriate options in lower risk cN1b patients. Further studies are warranted to refine treatment strategies in intermediate-risk cN1b PTC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10507256251401241","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T01:38:28Z","timestamp":1765417108000},"page":"36-45","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Are Total Thyroidectomy and Adjuvant Radioactive Iodine Treatment Required in All Patients with N1b Intermediate-High Risk Papillary Thyroid Carcinoma?"],"prefix":"10.1177","volume":"36","author":[{"given":"Takashi","family":"Fujiwara","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nozomu","family":"Kofuji","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yo","family":"Kishimoto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyomi","family":"Hamaguchi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shogo","family":"Shinohara","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Asato","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Ishida","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Kitani","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Shizuoka General Hospital, Shizuoka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuya","family":"Otsuki","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Tenri Hospital, Tenri, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Kusano","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Tsujimura","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Japan Red Cross Wakayama Medical Center, Wakayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kitano Hospital, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaori","family":"Yasuda","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisanobu","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Omori","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan."},{"name":"Department of Head and Neck Oncology and Innovative Treatment, Graduate School of Medicine, Kyoto University, Kyoto, 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