Postoperative quality of life in patients treated for thyroid cancer with transoral endoscopic and open surgery

Thyroid cancer treatments often impact patients' quality of life (QOL). The transoral endoscopic thyroidectomy vestibular approach (TOETVA) gets lot attention as a scarless alternative, but its influence on postoperative QOL remains unclear. This study compares TOETVA and open surgery outcomes regarding postoperative QOL, scar satisfaction, and mental health in thyroid cancer patients to inform surgical decision-making. We retrospectively analyzed 221 thyroid cancer patients treated between January 2017 and September 2024: 136 underwent open surgery, and 85 had TOETVA. QOL was assessed using the EORTC QLQ-C30 and THYCA-QOL questionnaires. Scar appearance was evaluated with the Patient and Observer Scar Assessment Scale (POSAS), and mental health with the Hospital Anxiety and Depression Scale (HADS). EORTC QLQ-C30 scores showed no significant difference in overall QOL between TOETVA and open surgery (global health status: 81.31 vs. 83.43, P = 0.420). The open surgery group had higher summary THYCA-QOL scores (15.33 vs. 12.41, P = 0.033). While univariate analysis linked TOETVA to fewer thyroid cancer-specific symptoms (P = 0.033), multivariate analysis did not (P = 0.198). TOETVA patients had better scar satisfaction (P < 0.001), confirmed by univariate and multivariate analysis. Anxiety (95.0%) and depression (88.2%) were common, with anxious symptoms in the TOETVA group nearing significance (P = 0.073). TOETVA significantly improves thyroid cancer-specific QOL and scar satisfaction but shows no difference in overall QOL compared to open surgery. These insights may guide surgical decision-making. In addition, attention to managing anxiety and depression is also essential.