Endoscopic hemithyroidectomy plus prophylactic central neck dissection via breast approach versus gasless transaxillary approach in treating low-risk papillary thyroid cancer: a retrospective series

Hemithyroidectomy plus prophylactic central neck dissection (pCND) has been adopted as a de-escalating surgical strategy for low-risk papillary thyroid cancer (PTC). This study aimed to evaluate and compare the outcomes of these two different endoscopic approaches in the treatment of PTC with hemithyroidectomy plus pCND. This retrospective study reviewed medical records of 545 patients receiving breast approach (ETBA) (n = 263) or gasless transaxillary approach (ETGTA) (n = 282) in treating PTC. Demographics and outcomes were compared between the two groups. Preoperatively, the two groups were similar in demographics. Regarding surgical outcomes, no differences were found in terms of intraoperative bleeding, total amount of drainage, duration of drainage, postoperative pain, hospital stay, vocal cord palsy, hypoparathyroidism, hemorrhage, wound infection, chyle leakage, or subcutaneous ecchymosis. Conversely, ETBA recorded fewer skin paresthesia (1.5% vs. 5.0%, respectively) but longer operative times (138.1 ± 27.0 vs. 130.9 ± 30.8 min,) and more swallowing disturbances (3.4% vs. 0.7%) compared to ETGTA (p < 0.05). No difference in scar cosmetic results, but ETBA had lower neck assessment score than ETGTA (2.6 ± 1.2 vs. 3.2 ± 2.0, p < 0.05). For low-risk PTC, endoscopic hemithyroidectomy plus pCND using either ETBA or ETGTA is both feasible and safe. Although the two approaches are comparable in terms of most surgical and oncological outcomes, ETBA is superior to ETGTA in terms of neck cosmetic results and skin paresthesia but is associated with more swallowing disturbances and requires a longer operative time.