Clinical comparative analysis of endoscopic thyroidectomy via the thoracoareolar approach versus open surgery for the treatment of differentiated thyroid cancer

The incidence of differentiated thyroid carcinoma has risen steadily in recent years, making it the most common thyroid malignancy. Surgical resection remains the primary treatment, but conventional open thyroidectomy (OT), while effective, often leaves prominent cervical scars that negatively affect aesthetics and quality-of-life. Endoscopic thyroidectomy (ET) via the thoracoareolar approach has been increasingly adopted, offering improved cosmetic outcomes and faster recovery, although evidence regarding its perioperative performance, complications, and follow-up outcomes remains limited. In this single-center retrospective cohort study, 150 patients with differentiated thyroid carcinoma treated between January 2020 and August 2023 were analyzed, including 70 who underwent ET and 80 who underwent OT. Baseline characteristics were comparable between groups. ET was associated with longer operative time but less intraoperative blood loss, shorter incisions, and more favorable postoperative recovery parameters, including earlier extubation, reduced hospital stay, and lower pain scores. Complication rates and the incidence of local recurrence or distant metastasis over 12 to 24 months did not differ significantly between groups, whereas quality-of-life scores (QLQ-C30) were significantly higher in the ET group. These findings suggest that thoracoareolar ET provides oncologic safety comparable to OT while conferring advantages in minimizing surgical trauma, accelerating recovery, and improving quality of life. ET may be particularly suitable for younger patients with greater cosmetic concerns, and further multicenter prospective studies are warranted to confirm its long-term efficacy and cost-effectiveness.