Feasibility and safety of modified en bloc resection in endoscopic thyroid surgery via bilateral areolar approach – Long-term institutional analysis 10 years after surgery

Abstract

Purpose This study aimed to introduce a new method of modified en bloc resection, evaluate its feasibility and safety in endoscopic thyroid surgery via bilateral areolar approach (BAA). Methods 108 and 213 papillary thyroid carcinoma (PTC) patients underwent lobectomy + ipsilateral central node dissection (CND) with modified en bloc method and conventional method via BAA were included in this study, and the patients were follow-up for an average of 10 years. The main outcomes including operative duration, lymph nodes yield (LNY), surgical complications, and the rate of recurrence and metastasis. Results There was no significant difference in terms of gender, age, tumor locations, tumor dominant nodule size, and the incidence concomitant Hashimoto thyroiditis in the clinicopathologic characteristics comparison. It was similar in the comparison of operative duration (P = 0.14), blood loss (P = 0.13), postoperative hospital stay (P = 0.58), incidence of transient vocal cord paralysis (P = 0.90) and hypocalcemia (P = 0.60). While the mean LNY achieved in the central compartment of Modified en bloc Group (7.5 ± 4.5) was significant more than it in Conventional Group (5.6 ± 3.6). Two patients in the Modified en bloc group and two patients in the Conventional group were found metastasis after surgery in the average 10 years follow up (1.8% vs. 0.9%, P = 0.60). In the analysis of learning curve, the operative duration of modified en bloc resection was significantly decreased from the 25-35th cases. Conclusions The method of modified en bloc resection in endoscopic thyroid surgery via BAA seems to be a technically feasible and safe procedure with excellent cosmetic results for selective PTC patients.