Endoscopic thyroidectomy for central lymph node dissection-is there a difference in the number of lymph node dissections performed through different surgical approaches? A retrospective cohort study and pooled data research.

Background: Endoscopic thyroidectomies are commonly performed for thyroid cancer. Previous studies indicated that trans-areola approach is inferior in central lymph node dissection (CLND) due to clavicle protruding. The present study aimed to compare different surgical approaches of endoscopic thyroidectomies regarding surgical outcomes.

Methods: Retrospective analysis of 153 patients underwent endoscopic thyroidectomies through oral and areola approaches from Nov. 2019 to Dec. 2022 in our institution, baseline information, surgical outcomes and postoperative complications were recorded and analyzed. For pooled data analysis, comprehensive searching was done to identify studies concerning comparison of endoscopic thyroidectomies. Basic information and surgical outcomes were extracted. RevMan 5.4 was used to analyze the pooled data. p < 0.05 was considered statistically different.

Results: A total of 153 patients were included with 75 in oral, 78 in areola. The operative time was longer in oral compared with other two groups. Number of lymph nodes, positive lymph nodes, hospital stay, postoperative drainage and complications were not different between the two groups. For the systematic review, five studies of oral and areola comparisons containing 568 patients was finally included in the meta-analysis. The operative time was slightly longer in oral group. Number of positive lymph nodes were slightly larger in areola. The blood loss, lymph nodes, hospital stay and transient hoarseness were not different between oral and areola.

Conclusions: Oral demanded more operative time than other approaches. Lymph nodes, positive lymph nodes and hospital stay were similar between different groups. Areola was comparable with oral in lymph nodes and positive lymph nodes.