Comparison of health‐related quality of life and cosmetic outcome between traditional gasless trans‐axillary endoscopic thyroidectomy and modified gasless trans‐axillary endoscopic thyroidectomy for patients with papillary thyroid microcarcinoma

BACKGROUND: Gasless trans‐axillary endoscopic thyroidectomy (GTET) has been proved to provide better cosmetic results; however, it has limitations as dissection of central neck lymph nodes is difficult. We developed a modified approach (MGTET‐modified GTET) and compared it with the traditional one in terms of patients' health‐related quality of life (HRQoL) and cosmetic results in order to provide more convincing therapeutic results. METHODS: Between January 2021 and June 2021, 100 cN0 patients who had a confirmed diagnosis of papillary thyroid microcarcinoma were randomized to undergo either MGTET (n = 50) or GTET (n = 50). These two groups' baseline characteristics, intraoperative and postoperative findings, were compared. The Patient and Observer Scar Assessment Scale (POSAS) was determined 6 months after surgery. Thyroid Cancer‐Specific Quality of Life Questionnaire was used to assess HRQoL at 1, 3, 6, and 12 months after surgery. RESULTS: M‐GTET was associated with a larger number of lymph nodes dissected (p < 0.001), lower drainage volume (p < 0.001), shorter hospital stay (p < 0.001), and shorter axillary incision (p < 0.001). POSAS was more favorable in M‐GTET. HRQoL was significantly better for MGTET in terms of less problems with scar (p < 0.001). CONCLUSION: Our study suggests that MGTET provides better therapeutic, cosmetic, and HRQoL outcomes.