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A prospective study comparing the gasless endoscopic thyroidectomy trans-axillary approach to conventional open thyroidectomy: health and quality of life outcomes

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Abstract

Background

The relationship between different surgical treatments and quality of life remains uncertain for differentiated thyroid carcinoma (DTC). The aim of this study is to compare the gasless endoscopic thyroidectomy trans-axillary approach (ET) and traditional open thyroidectomy (OT) through a prospective cohort study focusing on the rate of the efficacy, and quality of life (QoL).

Methods

This prospective observational longitudinal cohort study enrolled 134 female patients diagnosed with DTC from December 01/2021 to December 31/2022. Multiple scales were applicated to evaluate the differences in quality of life, effectiveness, safety, etc. between the two groups during preoperative and postoperative follow-up periods, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, version 3.0 (QOL-C30), Symptom Checklist (SCL-90), Scar Cosmesis Assessment and Rating (SCAR-Q), voice impairment score (VIS), swallowing impairment score (SIS), and neck impairment score (NIS).

Results

Among them, 68 accepted ET and 66 patients underwent OT. To enhance comparability between the two groups, the patients enrolled in this study are female. Compared with the OT group, the ET group performed significantly better postoperative physical quality of life, including sound (p = 0.036), swallowing (p < 0.001), and neck function (p = 0.010). The ET group was also associated with significantly better cosmetic satisfaction (p < 0.001), and relatively faster recovery in psychological and emotional situation.

Conclusions

Gasless endoscopic thyroidectomy through an axillary approach leads to good cosmetic and psychological effects, improves postoperative QoL, and could be recommended for rapid postoperative recovery and involvement in daily and social activities.

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Acknowledgements

The authors also thank all the patients included in this study.

Funding

This work was supported by the Sichuan University West China Hospital Discipline Excellence Development 1 · 3 · 5 Project (No. ZYJC21033).

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Author notes

  1. Tianfeng Xu and Xiangquan Qin have contributed equality to this work.

Authors and Affiliations

  1. Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Tianfeng Xu, Xiangquan Qin, Yujie Zhang, Pengyu Li, Yanhao Ran, Yuanyuan Fan, Xun Zheng & Tao Wei

  2. Department of Breast and Thyroid Surgery, Southwest Hospital, The First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, China

    Xiangquan Qin

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  1. Tianfeng Xu
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Contributions

TX: literature search, data collection, data analyses, manuscript drafting, and figures. XQ: study design, literature search, data analyses, manuscript drafting, and tables. TW and XZ contributed to surgical practices and review & editing. YZ, PL, YR, YF also contributed to data collection. All authors read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Xun Zheng or Tao Wei.

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Disclosures

Tianfeng Xu, Xiangquan Qin, Yujie Zhang, Pengyu Li, Yanhao Ran, Yuanyuan Fan, Xun Zheng, and Tao Wei have no conflicts of interest or financial ties to disclose.

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Xu, T., Qin, X., Zhang, Y. et al. A prospective study comparing the gasless endoscopic thyroidectomy trans-axillary approach to conventional open thyroidectomy: health and quality of life outcomes. Surg Endosc 38, 1995–2009 (2024). https://doi.org/10.1007/s00464-024-10689-y

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