Background. The American Thyroid Association guidelines do not mention isthmusectomy as an appropriate procedure for thyroid cancer. Despite this, a small number of patients present with lesions isolated to the thyroid isthmus, which can be excised without exploring the trachyesophageal grooves or total thyroidectomy. This study was designed to analyze outcomes in patients treated with isthmusectomy for small well-differentiated thyroid cancer (WDTC) at our institution. Methods. Nineteen patients with WDTC managed by isthmusectomy were identified from a database of 1,810 patients (1%) with WDTC managed by surgery in Memorial Sloan Kettering Cancer Center from 1986-2005. Demographic, surgical, pathological, and outcomes data were analyzed. Results. Six patients were men and 13 were women. The median age was 46 (range, 28-83) years. All patients had a solitary nodule confined to the thyroid isthmus. The median size of lesion was 1 (range, 0.4-3) cm. Eighteen patients had a pathologically T1 lesion (pT1), and one patient had a pT2 lesion. Two patients had papillary carcinoma detected in perithyroid lymph nodes (pN1a). There were no complications of recurrent laryngeal nerve palsy or hypocalcaemia. With a median follow-up of 124 (range, 53-276) months, the 10-year disease-specific survival was 100% and 100% local and regional 10-year recurrence-free survival. Conclusions. Our results suggest that isthmusectomy alone may be sufficient treatment for selected patients with small WDTC limited to the isthmus. This procedure has the benefit of avoiding dissection of the recurrent laryngeal nerve and parathyroid glands, thus limiting postoperative complications.