Background: Although Papillary thyroid carcinoma (PTC), has a high prevalence but it is not a fatal malignancy, so, any studies pointed to using less aggressive conservative surgical approaches as management strategies for PTC, including the option of hemi- thyroidectomy for small PTC up to 4 cm.The extent and type of surgical approaches for PTC is still controversial. In the current retrospective study, we aimed to explore the long-term outcome of patients with PTC patients who underwent he- mithyroidectomy in comparison with similar stage PTC patients who underwent total thyroidectomy. Patients and methods: This is a retrospective comparative cohort study included fifty patients with a proven diagnosis of PTC. Of the 50 included patients, 20 patients underwent hemi-thyroidectomy and 30 patients underwent total thyroidectomy. We followed all patients for about 3 years to detect recurrence and survival rates. Results: we showed that patients who underwent total thyroidectomy were older than patients underwent hemi-thyroidectomy (p=0.039). Patients who underwent total thyroidectomy have high liability of; extra-capsular invasion (p=.002), higher stage (p=0.005), higher incidence of cervical lymph nodes metastases (p=0.006), performing lymph node dissection (p=0.008), post- operative hypocalcemia (p=0.001), and laryngeal nerve paralysis (p=0.008), than patients underwent hemi-thyroidectomy. No signifi- cant differences in recurrence and survival between patients who underwent total thyroidectomy or hemi-thyroidectomy. Conclusion: hemi-thyroidectomy in adequately selected cases could be an excellent surgical approach for management of PTC which yielded curative results with fewer post-operative complications.