Analysis of Factors Influencing Surgical Approach Selection in Patients with Thyroid Cancer: A Retrospective Study of 411 Cases

Thyroid cancer is the most common malignancy of the endocrine system, and its incidence has risen rapidly over the past decade. It is more prevalent in females, with a male-to-female ratio ranging from 1:2 to 1:3. Thyroid cancer is generally classified into differentiated thyroid carcinoma (DTC), medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC). DTC is further subdivided into papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). According to current domestic and international guidelines, surgery remains the only curative treatment for differentiated thyroid carcinoma (DTC). The commonly performed surgical approaches include conventional open thyroidectomy (COT) and endoscopic thyroidectomy (ET). Among open surgeries, the most commonly used approach is the conventional midline cervical incision. In endoscopic procedures, the gasless unilateral axillary approach (GUA) is particularly favored by patients. Therefore, this study aims to investigate the factors influencing the choice of surgical approach for thyroid cancer, which will contribute to further standardizing perioperative management. This study is a single-center retrospective analysis that categorized patients based on the Asian BMI classification and surgical approach. It compared key preoperative, intraoperative, and postoperative indicators between different surgical methods, and conducted both regression and logistic regression analyses. The results demonstrated significant differences between endoscopic and open surgeries across various BMI groups, with the choice of surgical approach exerting a notable impact on relevant clinical indicators. However, BMI itself did not show a significant influence on factors such as operative time, postoperative drainage volume, or the number of lymph nodes dissected. Interestingly, in the obese population, BMI was significantly correlated with nodule size, which in turn was closely associated with clinical N (cN) staging. These findings suggest that BMI may serve as a potential risk predictor, ultimately influencing the selection of surgical approach.