الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 89 |  |  |
| | | from | 89 | | |
Abstract
Our work in this study shows that the incidence of recurrence post hemi thyroidectomy is significantly higher compared to post total thyroidectomy and in case of multifocal and insular carcinoma with hemi thyroidectomy it increases the incidence of recurrence and drastically affecting the 10-year survival rate and the quality of life.
One of the most important risk factors is lymph node metastasis at the time of initial surgery as it increases the incidence of recurrence and as aforementioned it can be missed by neck ultrasound so it is recommended to use fine needle aspiration cytology for suspicions lymph node at the pre-operative assessment and for advanced cases it is recommended to study the possibility of sentinel lymph node assessment by frozen section.
LNR is a very useful quantitative measure for lymph node metastasis and should be added to the guide lines as a post operative prognostic tool.
Extra capsular extension is an absolute indication for total thyroidectomy.
Also, the tumor size as multiple studies have insinuated that ≥2 cm increases the recurrence but the ATA guidelines state that <4cm is an indication for hemi thyroidectomy so it is recommended to study which might have better outcome for tumor size.
Advanced age was observed to be not a significant risk factor but on the contrary the younger the patient is more recurrence is observed this may be due to the age-related in the elderly, it is not recommended to be lenient in the elderly or aggressive with the young for the management upon this information.
Multifocality and insular carcinoma and bilaterality increase the incidence of recurrence drastically so it is recommended for total thyroidectomy.
Gender plays a role in the aggressiveness of the tumor but not in the incidence of recurrence as this is determined by the selection criteria of the candidate and the surgical technique
We studied 7 risk factors through this meta-analysis and it is recommended for application of LNR as a post op prognostic tool for recurrence and to apply hemi thyroidectomy for tumor size <2 cm instead of <4 also meticulous pre-operative workup, accurate risk assessment, stratification and staging this is to customize a road map for every patient through a multi-disciplinary team.