Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: A two-centre study. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Zheng, Guibin; Ma, Chi; Sun, Haiqing; Wu, Guochang; Guo, Yawen; Wu, Guoyang; Zheng, Haitao
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 6(2021)
• Page Start: 1346
• Page End: 1351
• Publication Date: 2021-06
• Subjects: Central lymph nodes dissection -- Oncological safety -- Papillary thyroid cancer -- Transoral endoscopic thyroidectomy; TOETVA transoral endoscopic thyroidectomy vestibular approach -- PTC papillary thyroid cancer -- TT total thyroidectomy -- CND central neck dissection -- EBSLN external branch of the superior laryngeal nerve -- PG parathyroid gland -- RLN recurrent laryngeal nerve -- CNLN Central neck lymph node -- Tg thyroglobulin; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.01.028
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Objective: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been increasingly used to treat patients with papillary thyroid cancer (PTC) with improved cosmetic outcomes. This study aimed to explore the safety and efficacy of TOETVA in patients with PTC. Materials and methods: This retrospective study included TOETVA patients from Yantai Yuhuangding and Xiamen Zhongshan Hospitals. Among the 297 patients studied, 84 had benign nodules (28.3%), 208 had PTC (70.0%), and five had follicular thyroid cancer (1.7%). Results: The incidence of transient and permanent recurrent laryngeal nerve injury was 1.3%, while that of transient hypoparathyroidism was 1.0%. Mental nerve paraesthesia was observed in 241 cases (81.1%), while permanent mental nerve paraesthesia was noted in seven cases (2.4%). Abnormal motor function of the lower lip and chin was observed in 12 cases (4.0%). Ten of the 208 patients with PTC (4.8%) underwent total thyroidectomy (TT) and bilateral central neck dissection (CND). A mean 6.6 ± 4.1 and 10.9 ± 4.0 lymph nodes were removed in the unilateral and bilateral surgeries, respectively, with a metastasis rate of 49.0%; a mean 2.7 ± 2.3 and 3.2 ± 2.6 lymph nodes were metastatic, respectively. The parathyroid gland was inadvertently removed in 6.6% and auto-transplanted in 10.6% of patients with unilateral PTC. The non-stimulated thyroglobulin level in the TT and bilateral CND patients was below 1 ng/mL at the 6-month follow-up. Conclusion: TOETVA is safe in well-selected patients with unilateral PTC. However, its safety remains unclear in patients treated with TT and bilateral CND. Highlights: ● TOETVA can be performed safely for unilateral PTC ● The difficulty of lower parathyroid glands protection in TOETVA adds the risk of permanent hypoparathyroidism in bilateral PTC ● Abnormal motor change could occur after TOETVA but all transient ● Mental nerve paraesthesia was commonly after TOETVA, but lacking criteria for evaluation ● TOETVA showed a good oncological safety in a short-time follow-up