title: The perception of scar cosmesis following thyroid and parathyroid surgery: A prospective cohort study.
abstract: BACKGROUND
  Various "scarless" approaches have been described for thyroid and parathyroid surgery. The objective of the current study was to investigate patients' perception of neck scar cosmesis, its impact on quality of life (QoL) and evaluate patient preference with regards to scar location.
  
  
  METHODS
  120 patients undergoing thyroid or parathyroid surgery were followed-up over a 5-year period (2008-2013). Validated tools were used to assess scar perception and its impact on QoL. These were evaluated against sex, age, ethnicity, operation type, histopathology, time following surgery and scar length.
  
  
  RESULTS
  Mean follow-up was 2.6 ± 3.8 years. One of the most common post-operative problems was scar-related (n = 18). Caucasian patients and those with benign histology expressed a lower impact on QoL (p < 0.001, p = 0.038). Sex and scar length did not significantly affect patients' perception for scar cosmesis (p > 0.05). Clinicians tended to score scar cosmesis higher than patients (p = 0.02). Most participants (75%) expressed a clear preference for an extracervical "scar-less in the neck" approach.
  
  
  CONCLUSIONS
  Scar-related issues are frequently reported following thyroid and parathyroid surgery. The negative impact, often underestimated by clinicians, is more apparent amongst Asian and Afro-Caribbean patients and can significantly impact on their QoL. This, combined with the lack of correlation between scar length and patient satisfaction, indicates the need to divert research from miniaturising neck scars to concealing them in extracervical sites.
  
  
  CONCLUSIONS
  Patients prefer a scar-less in the neck approach when given the option. A prospective comparative study is required to compare the cervical and extracervical approaches.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK. Electronic address: asitarora@doctors.org.uk.
authors.forename: Asit
authors.initials: A
authors.lastname: Arora
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: Chloe
authors.initials: C
authors.lastname: Swords
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: George
authors.initials: G
authors.lastname: Garas
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Chaidas
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: Alexa
authors.initials: A
authors.lastname: Prichard
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: James
authors.initials: J
authors.lastname: Budge
authors.affiliation: Human Anatomy Unit, Department of Surgery and Cancer, Imperial College London, W6 8RP, UK.
authors.forename: D Ceri
authors.initials: DC
authors.lastname: Davies
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Tolley
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000473:pathology / Q000517:prevention & control / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D010280:Parathyroid Glands / Q000601:surgery*; D057240:Patient Preference; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012737:Sex Factors; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D006113:United Kingdom
keywords: Parathyroidectomy; Quality of life; Robotic; Scar cosmesis; Thyroidectomy