Abstract
BACKGROUND: Conventional open surgery (OP) is effective and simple for treating papillary thyroid cancer (PTC), but the excessive separation of band strap muscles causes discomfort in the anterior cervical region and a long scar, which may impair the patient's life quality and beauty. Gasless endoscopic surgery via subclavicular approach (ESSA) may provide a better alternative. METHODS: The prospective data of 90 PTC patients who underwent ESSA or OP (45:45) in hemithyroidectomy and central neck dissection (CND) in our center from March 2022 to August 2023 were analyzed. Safety indicator incidence of complications, efficiency indicator No. lymph nodes (LNs) of CND, postoperative recurrence of central neck LNs indicated by Ultrasound (US) at 6 months, postoperative functions of the anterior cervical region and cosmetic satisfaction were recorded as the primary endpoints. RESULTS: The ESSA group had no significant differences with the OP group in baseline data, complications, No. LNs (9.04 ± 4.58 vs. 9.87 ± 4.89, p = 0.413) and metastatic LNs (1.60 ± 2.79 vs.1.69 ± 2.50, p = 0.874) of CND. The two groups had no postoperative recurrence of central neck LNs indicated by ultrasound (US) at 6 months. The ESSA group exhibited better functionally sensitive and motional outcomes in the anterior cervical region compared to the OP group (P = 0.0217 and P = 0.008), and had higher cosmetic satisfaction than the OP group (P < 0.001). CONCLUSION: Compared with OP, ESSA is equally safe and effective, but more cosmetic and conducive to preserving functions of the anterior cervical region. ESSA can be considered an alternative approach to OP in hemithyroidectomy and CND.