Patient-reported outcomes by individuals with differentiated thyroid cancer who underwent minimal-access versus conventional open thyroidectomy: a real-world propensity score-matching study.

BACKGROUND

Minimal-access surgery has been widely used in differentiated thyroid cancer (DTC) management and its therapeutic effectiveness is well-proven. However, little is known about how minimal-access thyroidectomy affects patient-reported outcomes (PRO).

MATERIALS AND METHODS

In this real-world cross-sectional study, 6221 patients with DTC who underwent minimal-access or conventional open thyroidectomy were included and required to fill out PRO questionnaires, including the Thyroid Cancer-Specific Quality of Life, the European Organisation for Research and Treatment of Cancer's Core Quality of Life Questionnaire, and Fear of Progression Questionnaire-Short Form. Of the 3586 patients who completed the questionnaires entirely, 915 and 2671 belonged to the minimal-access and open groups, respectively. To reduce bias and balance confounding factors, propensity score matching was performed, after which 1818 patients were equally divided between the two groups.

RESULTS

Compared with the open group, the minimal-access group reported better PRO in terms of the THYCA-QOL summary score ( P < 0.001), neuromuscular ( P = 0.038), voice ( P < 0.001), concentration ( P = 0.044), sympathetic ( P = 0.002), throat/mouth ( P < 0.001), and scar ( P < 0.001), feeling chilly ( P < 0.001), and tingling hands/feet ( P = 0.002). Subgroup analysis demonstrated that minimal-access thyroidectomy can be optimal for most patients from the PRO perspective. Moreover, longitudinal PRO comparisons indicated that at ≤6 months postoperatively, the open group experienced more problems in neuromuscular, voice, sympathetic, throat/mouth, scar, feeling chilly, tingling hands/feet, headache, and lower global health status scores (all P < 0.05). However, except for voice, scar and tingling hands/feet, nearly all the differences disappeared after 7 months postoperatively. Intergroup comparisons suggested that the minimal-access group required less time to recover to a stable state.

CONCLUSIONS

The minimal-access group exhibited significantly superior postoperative PRO compared to the open group. Furthermore, the PRO trajectories of the two groups differed, with the minimal-access group demonstrating a considerably shorter recovery time. If better PRO is desired, minimal-access thyroidectomy may be preferred.