Postoperative Cosmetic Outcomes and Quality of Life After Thyroidectomy: A Systematic Review and Network Meta-Analysis.

Abstract

Remote-access thyroidectomy and minimally invasive video-assisted thyroidectomy (MIVAT) were developed to improve cosmesis over the conventional transcervical approach (CTA). However, comparative data on cosmetic and quality of life (QOL) outcomes remain limited. A systematic review and random-effects network meta-analysis was performed to compare MIVAT, five remote-access approaches-breast approach (BA), bilateral axillo-breast approach (BABA), gasless transaxillary approach (GTAA), retroauricular approach (RA), and transoral approach (TOA)-with CTA. Fifty-seven studies (9206 patients) were included. All remote-access techniques and MIVAT showed superior cosmetic outcomes versus CTA. TOA and BABA ranked highest. Remote-access approaches, particularly TOA, BABA, and GTAA, demonstrated generally better QOL outcomes than CTA and MIVAT. Remote-access approaches and MIVAT offer superior cosmesis over CTA. TOA and BABA generally rank highest in both cosmesis and QOL, although evidence on QOL remains limited. These approaches may be considered for patients prioritizing aesthetic and psychosocial outcomes.