Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis

Jiang, Wenjie; Yan, Peijing; Zhao, Chunlin; Si, Moubo; Tian, Wen; Zhang, Yanjun; Tian, Hongwei; Feng, Shuangwu; Han, Caiwen; Yang, Jia; Yang, Kehu; Guo, Tiankang

doi:10.1007/s00464-019-07283-y

Cited by 45 publications

(46 citation statements)

References 31 publications

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“…Other meta-analyses also found no statistical difference in hypocalcemia between minimally invasive techniques and conventional thyroidectomy (112,117,119). Only Jiang et al reported a lower incidence of hypocalcemia after the endoscopic technique (116). The RA-ET and RA-RT could not be included in the meta-analysis, because of lacking control arms.…”

Section: Discussionmentioning

confidence: 98%

“…This systematic review and meta-analysis shows that minimally invasive techniques are not inferior to cervical thyroidectomy with regards to length of hospital stay, transient RLN injury, permanent RLN injury, transient hypocalcemia and permanent hypocalcemia. Prior to this study, multiple systematic reviews have been published regarding either the robotic thyroidectomy techniques or endoscopic thyroidectomy techniques (111)(112)(113)(114)(115)(116)(117)(118)(119). However, these systematic reviews combine the different types of techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Outcomes of Minimally Invasive Thyroid Surgery (112,114,116,117,119). However, length of hospital stay is not a good metric to assess the best thyroidectomy approach, since it is mostly determined by local prevailing hospital protocols rather than outcome of surgery.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

et al. 2021

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PurposeConventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy.MethodsA systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques.ResultsOut of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques.ConclusionsThis is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

et al. 2021

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“…With the development of minimally invasive surgery, BABA has become a well-established surgical technique with many reported benefits (4,5,15). Most recently, a large case-based meta-analysis (5) concluded that the efficacies and safety of total endoscopic thyroidectomy (TET) through multiple approaches, including but not limited to BABA, unilateral axillo-breast approach (UABA), anterior chest wall approach, and transoral approach, were similar to TOA for the treatment of thyroid cancer by comparison of the relevant indicators such as the level of surgical completeness, tumor recurrence rates, and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, patients no longer only value the survival and recovery of disease; they now greatly value postoperative cosmetic outcomes, especially in head and neck surgery. Therefore, as one of the novel surgical methods, minimally-invasive neck surgery with multiple approaches including, but not limited to, bilateral axillabreast approach (BABA) and transoral approach, have been demonstrated to be safe, efficacious, and perfectly meet the requirements of better cosmetic outcomes compared with traditional open approaches (TOA) (4,5). To the best of our knowledge, this was the first case of solitary cervical VNN resection via BABA in the Chinese population, providing a new horizon for the therapeutic indications of endoscopic surgery for neck tumors.…”

Section: Introductionmentioning

confidence: 99%

Resecting a solitary cervical vagal nerve neurofibroma via endoscopic surgery: a case report

Luo¹,

Min²,

Zeng³

et al. 2021

Gland Surg

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Neurofibromas predominately consist of Schwann cells and fibroblasts, which mainly originate from neurofibromatosis type 1. However, solitary cervical vagal nerve neurofibroma (VNN) has rarely been reported in previously published literature. Additionally, the onset of VNN is characteristically chronic, asymptomatic, and insidious, and is often discovered unexpectedly through physical examination or imaging. The exact etiology and pathogenesis of VNN are yet to be clarified and need further exploration.Consequently, the definitive diagnosis of VNN mainly depends on pathological and immunohistochemical examinations. Immunohistochemically, tumor cells are positive for transcription factor S-100, SRYrelated HMG-box (SOX)-10, and vascular marker CD34 will contribute to the diagnosis of VNN. In this uncommon case of left cervical VNN, the patient received comprehensive radiological evaluation before the operation and then underwent mass resection through endoscopic surgery via an axillary and chest wall approach. The patient was satisfied with the postoperative appearance of the neck. Besides, no postoperative complications or recurrence were observed during the consecutive six-month follow-up. Therefore, the successful application of total endoscopic surgery via the bilateral axilla-breast approach (BABA) on this case of neurogenic tumor presents new insights into expanding the operative indications of this technique, which could be a rational candidate for this kind of neck tumor with the requirements of satisfactory aesthetic appearance.

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Comparison of quality of life and cosmetic result between open and transaxillary endoscopic thyroid lobectomy for papillary thyroid microcarcinoma survivors: A single‐center prospective cohort study

Zhang

Chen

et al. 2022

Cancer Medicine

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Background: Transaxillary endoscopic thyroidectomy has been introduced to achieve better cosmetic outcomes. However, the benefits of this technology on the patients' health-related quality of life (HRQoL) remain unclear. We aimed to investigate whether transaxillary endoscopic lobectomy is comparable to conventional open lobectomy in terms of QOL and cosmetic results in order to provide more evidence for establishing appropriate clinical decisions. Methods: Between August 2019 and May 2020, transaxillary endoscopic lobectomy and conventional open lobectomy were performed in 73 and 99 patients with papillary thyroid microcarcinoma, respectively. HRQoL was assessed at 1, 3, 6, and 12 months after surgery using the Thyroid Cancer-Specific Quality of Life Questionnaire. The cosmetic outcomes were assessed 12 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS).Results: No significant difference was observed in the surgical results between the two groups. However, the data showed that the average operative time and postoperative hospital stay of the transaxillary group were longer than those of the open group (p < 0.001). Both groups showed similar changes in the QOL scores over time. However, the transaxillary group had fewer complaints of the throat or oral problems at 1 month postoperatively than the open group (p < 0.001).During the follow-up, the cosmetic results of scars in the transaxillary group were significantly better than those in the open group (p < 0.05). Patients who underwent transaxillary endoscopic lobectomy had higher overall satisfaction with their scar appearance, determined using POSAS, at 12 months postoperatively. Conclusions:The current findings suggest that transaxillary endoscopic lobectomy may offer better cosmetic and HRQoL outcomes.

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Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis

Cited by 45 publications

References 31 publications

Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

Resecting a solitary cervical vagal nerve neurofibroma via endoscopic surgery: a case report

Comparison of quality of life and cosmetic result between open and transaxillary endoscopic thyroid lobectomy for papillary thyroid microcarcinoma survivors: A single‐center prospective cohort study

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