The role of mitoxantrone hydrochloride in lymph node harvesting and parathyroid gland identification in conventional and endoscopic thyroidectomy.

Introduction: This retrospective study investigates the role of Mitoxantrone Hydrochloride Injection (MHI) in enhancing lymph node yield and protecting the parathyroid glands (PGs) in conventional and endoscopic thyroid surgery. Methods: A retrospective analysis was performed on 397 thyroid cancer patients who underwent surgery from May 2023 to May 2024. The patients were divided into MHI and control groups based on the intraoperative use of MHI. Clinical data, including lymph node harvest and PGs identification, as well as perioperative parathyroid hormone and calcium levels, were reviewed. Results: The study included 258 patients in the conventional surgery cohort and 139 in the endoscopic cohort (transoral, axillary, and periareolar approaches). No MHI-related complications were observed. In the conventional surgery cohort, MHI increased the lymph node yield per unilateral central neck dissection from 4.59 to 5.89, and in the endoscopic cohort, from 4.15 to 5.29. No difference was observed in the identification of superior PGs between groups. MHI enhanced the identification of inferior PGs from 42.45% to 60.87% in the conventional surgery cohort and from 41.00% to 60.92% in the endoscopic cohort. However, during the follow-up period, there was no significant difference in the incidence of hypoparathyroidism between the groups. Conclusions: MHI is a safe and effective adjunct for thyroid surgery, improving lymph node detection and inferior PGs exposure, although its measurable impact on postoperative parathyroid function in a high-volume center appears limited.