Comparison Of Endoscopic Thyroid Surgery Through The Transoral Approach And Areolar Approach And Open Surgery For Papillary Thyroid Cancer In Young Women: A Retrospective Study At A Single Center

Objective To investigate the advantages and disadvantages of endoscopic thyroid surgery through the transoral approach,areolar approach and open surgery for papillary thyroid carcinoma in young women.MethodsThe retrospective analysis was performed using the clinical records of 136 young women who had received radical thyroidectomy through three different approaches from January 2017 to December 2021.They were divided into three groups depending on different approaches: the open group had 51 patients who underwent open radical thyroid cancer surgery,the transoral group had 16 patients who received endoscopic thyroidectomy through the transoral approach,and the areolar group had 69 patients who received endoscopic thyroidectomy through the mammary areolar approach.Comparisons among the three groups included age,sex,body mass index,location and diameter of the lesions,operation time,preoperative and postoperative systolic blood pressure,diastolic blood pressure and heart rate difference,total number of pathological lymph nodes and whether parathyroid tissue was found in postoperative pathology or not,variation in serum parathyroid hormone and calcium levels after surgery,postoperative hospitalization duration,total postoperative drainage and relevant complications.ResultsWe did not find serious complications in any of the 136 patients and no intermediate opening was performed in the two endoscopic groups.All patients were confirmed to have papillary thyroid cancer by postoperative pathology.The time of surgery and hospital cost in the three groups were significantly different(P<0.05).The open group had the shortest surgery time and lowest cost among the three groups while transoral group has the longest surgery time and the most hospital costs.Total postoperative drainage was significantly different(P<0.05).The areolar group had the most drainage,and there was no significant difference between the open group and the transoral group.Other relevant data were not significantly different among the three groups.ConclusionFor papillary thyroid cancer in young women,either open surgery or endoscopic surgery through transoral or areolar approach all can achieve a radical curative level,and barely along with serious complications.However,the transoral approach and the total areolar approach hardly leave surgical scar on the neck and offer significant aesthetic advantages over open surgery as young women may have a clear aesthetic need for the neck.In addition,open surgery has significant advantages in operating time and hospital cost.In fact,all three approaches can be widely used in the treatment of most thyroid cancers.However,we also need to consider each patient’s overall conditions fully in order to balance the diagnosis and treatment of the disease with patient’s aesthetic requirements better.