Comparison of Transoral Endoscopic Thyroidectomy via the Vestibular Approach and Conventional Open Thyroidectomy for Papillary Thyroid Carcinoma: A Propensity Score-Matched Analysis.

Abstract

Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) has gained popularity for treating papillary thyroid cancer (PTC). This study aimed to evaluate the oncologic and surgical outcomes of TOETVA with open thyroidectomy (OT) for PTC. We retrospectively enrolled patients with PTC with preoperative assessment of tumor diameters ≤ 2 cm who underwent TOETVA (n = 59) or OT (n = 324). Then, a total of 177 patients were matched at a ratio of 1:2 using the propensity score matching (PSM) analysis. Oncological outcomes, surgical outcomes, and follow-up data were assessed between the two cohorts. With PSM employed to establish an equivalent control group, patients in the TOETVA group had a notably longer operative time (p < 0.001), elevated postoperative white blood cell count (p < 0.001), increased C-reactive protein (p < 0.001), extended postoperative hospital stay (p < 0.001), augmented operation cost (p < 0.001), and a reduced total number of retrieved central lymph nodes (p < 0.001). Other surgical outcomes showed no statistical difference between the groups. Mental nerve injury was higher in the TOETVA group than in the OT group (p = 0.004), but other complications were similar between the groups. In terms of central lymph node metastasis, no recurrences in the OT group were observed, whereas one recurrence in the TOETVA group was reported, with no significant difference in the two groups. Despite several perioperative disadvantages, TOETVA can achieve comparable oncologic outcomes to OT. Thus, it is an option that offers cosmetic benefits for patients with early stage PTCs.