Endoscopic Total Thyroidectomy via a Single-Port Subclavian Approach Versus Open Surgery for Papillary Thyroid Carcinoma.

Abstract

Objective: Historically, performing contralateral thyroid lobectomy and lymph node dissection via the subclavian approach has been considered challenging. This study evaluated the safety and feasibility of gasless endoscopic total thyroidectomy and central compartment neck dissection via the single-port subclavian approach (SpSCA) in comparison with conventional open surgery for the treatment of papillary thyroid carcinoma (PTC).

Methods: Between January 2019 and June 2023, 120 patients diagnosed with PTC were retrospectively enrolled into this study, with 26 undergoing the SpSCA procedure and 94 receiving conventional surgery. Propensity score full matching was used to balance baseline characteristics between the groups. Subsequently, weighted regression analyses (adjusted for age) were used to compare perioperative outcomes, complications, survival, and esthetic results between the groups.

Results: After matching, the SpSCA procedure was associated with a significantly longer operative time than open surgery (adjusted difference: 37.3 min, 95% confidence interval [CI]: 16.5-58.2). However, no significant differences were noted in postoperative hospital stay, bleeding volume, drainage volume, or major complications between the groups. During the median follow-up period of 34-36 months, biologic events occurred in six patients who underwent open surgery and one patient who underwent SpSCA; no structural events were observed. Disease-free survival curves were similar between the groups. The SpSCA group exhibited significantly higher esthetic satisfaction scores (adjusted difference: 2.26, 95% CI: 1.56-2.96).

Conclusion: The SpSCA approach is a safe and feasible alternative to conventional surgery for selected patients with PTC, offering superior esthetic results and comparable clinical outcomes.