The Transareola Endoscopic Approach Yields Adequate Oncological Dissection as Open Approach in the Treatment of Papillary Thyroid Carcinoma

Objective: This study aimed to evaluate and discuss whether the transareola endoscopic surgery has similar outcome outcomes to open surgery in the treatment of papillary thyroid carcinoma (PTC). Method: A total of 102 patients with PTC were enrolled in this study. Among them, 53 patients were treated by transareola endoscopic surgery (endoscopic group) and 49 patients were treated by open surgery (open group). Some specific factors, including thyroglobulin (Tg), radioactive iodine uptake (RAIU), postoperative nuclide imaging in thyroid area, postoperative nuclide imaging of lymph nodes suspicious for metastasis (PNILNSM), etc. were analyzed and compared between the 2 groups. Results: There were no significant differences between the 2 groups regarding body mass index (22.9±3.4 vs. 24.0±3.3, P =0.103), operation time (173.3±43.2 vs. 158.8±47.9 min, P =0.110), intraoperative blood loss (41.8±19.4 vs. 35.8±31.0 mL, P =0.251, P =0.251), tumor diameter (19.0±6.8 vs. 20.2±7.2 mm, P =0.400), and overall complications (11.3% vs. 10.2%, P =0.868). No significant difference was found in the specific factors between the 2 groups concerning RAIU-2h/24h (2.44±1.34 vs. 2.58±1.65%/2.83±3.75 vs. 2.35±3.44%, P =0.646/ P =0.506), number of dissected lymph nodes (4.4±1.4 vs. 4.6±1.5, P =0.595), Tg before radioiodine therapy (4.46±5.50 vs. 5.60±8.36; P =0.495), Tg after radioiodine therapy (1.03±1.93 vs. 1.11±1.61, P =0.812, P =0.812), postoperative nuclide imaging in thyroid area (1.76±1.50 vs. 2.19±1.85 cm 2 , P =0.195), PNILNSM before radioiodine (none: 79.2% vs. 83.7%, P =0.566; central: 17.0% vs. 12.2%, P =0.653; lateral: 1.9% vs. 4.1%, P =0.450; central+lateral: 1.9% vs. 0%, P =1.000), and PNILNSM after radioiodine (none: 94.3% vs. 95.9%, P =0.111; central: 3.8% vs. 2.0%, P =1.000; lateral: 0 vs. 2.0%, P =0.480; central+lateral: 1.9% vs. 0%, P =1.000). Conclusions: Transareola endoscopic total thyroidectomy and central lymph nodes dissection are safe and effective. According to the evaluated postoperative specific factors, this technique achieves similar outcomes to open surgery in selected patients with PTC.