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.