Objectives: Previous studies have shown different prognostic impacts of tumor size and minimal extrathyroidal extension (ETE) in patients with papillary thyroid carcinoma (PTC). Therefore, we examined the prognostic value of tumor size and ETE on recurrence in pathological T1 to T3 PTC patients. Methods:This study involved 2916 consecutive patients who underwent thyroidectomy for previously untreated PTC at our tertiary referral center. Tumor size was determined on pathological examinations and minimal or macroscopic ETE were identified by operative and pathological findings. Univariate and multivariate Cox proportional hazard regression analyses were used to determine significant factors predictive of post-treatment recurrence-free survival (RFS). Result:Minimal and macroscopic ETE were found in 1334 (45.7%) and 331 (11.4%) patients, respectively. Tumor size and ETE were significantly associated with pathological lymph node metastasis (all P <0.01) and post-treatment recurrence (all P <0.01). Tumor size did not differ or modify its impact on post-treatment recurrence along different age (P >0.05). Minimal ETE as well as macroscopic ETE were significantly associated with RFS (P <0.01). However, in multivariate analysis, no minimal but macroscopic ETE was the independent factor of RFS (P <0.05). Conclusion:No minimal but macroscopic ETE impacts on RFS after thyroidectomy in patients with T1 to T3 PTC.