Clinical Comparative Study of Total Endoscopic, Endoscopic-Assisted, Open Thyroidectomy for cT1N0 Differentiated Thyroid Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FEIYang ¹ , YAOJing ¹ , LIYang ¹ , WANGShi-jie ¹ , WANGShi-bin ¹ ,  TIANWen ²

1. Department of General Surgery, The First Affiliated Hospital of PLA General Hospital, Beijing 100048, China;
2. Department of General Surgery, PLA General Hospital, Beijing 100853, China;

Corresponding author：

TIANWen, Email: tianwen301@sina.com

Keywords：

Early stage thyroid cancer; Thyroidectomy; Lymph node dissection; Endoscope

DOI：

10.7507/1007-9424.20150154

Video：

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Objective To explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. Methods The clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. Results All the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). Conclusions Endoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.

Citation： FEIYang, YAOJing, LIYang, WANGShi-jie, WANGShi-bin, TIANWen. Clinical Comparative Study of Total Endoscopic, Endoscopic-Assisted, Open Thyroidectomy for cT1N0 Differentiated Thyroid Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(5): 586-590. doi: 10.7507/1007-9424.20150154 Copy

1.	Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4):225-249.
2.	Miccoli P, Materazzi G, Berti P. Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers:indications and limits. Curr Opin Otolaryngol Head Neck Surg, 2010, 18(2):114-118.
3.	Miccoli P, Berti P, Raffaelli M, et al. Minimally invasive videoassisted thyroidectomy. Am J Surg, 2001, 181(6):567-570.
4.	Ikeda Y, Takami H, Sasaki Y, et al. Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc, 2002, 16(12):1741-1745.
5.	王圣应, 朱正志, 彭德峰, 等.分化型甲状腺癌颈淋巴结转移规律的研究.中华外科杂志, 2008, 46(18):1404-1406.
6.	Hüscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endosc, 1997, 11(8):877.
7.	Miccoli P, Berti P, Conte M, et al. Minimally invasive surgery for thyroid small nodules:Preliminary report. J Endocrinol Invest, 1999, 22(11):849-851.
8.	Kitano H, Fujimura M, Kinoshita T, et al. Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc, 2002, 16(1):88-91.
9.	王平.腔镜甲状腺癌根治术的现状与展望.外科理论与实践, 2011, 16(6):522-525.
10.	李志宇, 王平, 林信斌, 等.经胸乳人路内镜手术治疗甲状腺乳头状癌85例临床分析.中华普通外科杂志, 2011, 26(6):485-488.
11.	祝玉祥, 章佳新, 蔡凤林, 等.全腔镜手术与传统手术治疗早期分化型甲状腺癌的临床比较.中国普通外科杂志, 2014, 23(5):605-608.
12.	陈光, 吕智, 王培松, 等.改良Miccoli术式微创甲状腺癌根治术302例.中华腔镜外科杂志:电子版, 2013, 6(3):222-225.
13.	张伟, 仇明, 江道振, 等.完全腔镜与中转开放甲状腺癌根治术的比较.中国微创外科杂志, 2012, 12(1):33-35.
14.	Kim JH, Choi YJ, Kim JA, et al. Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach. Surg Laparosc Endosc Percutan Tech, 2008, 18(2):197-201.
15.	于金玲, 任建强, 周予民, 等.经胸壁入路内镜甲状腺切除术与开放甲状腺切除术围手术期创伤因素的对比研究.腹腔镜外科杂志, 2010, 15(1):27-30.
16.	孙志刚, 陆涛, 卢榜裕, 等.腔镜与传统甲状腺手术对机体免疫功能的影响.中国微创外科杂志, 2009, 9(1):62-65.
17.	Ikeda Y, Takami H, Sasaki Y, et al. Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg, 2003, 196(2):189-195.
18.	Hong JY, Kim WO, Chung WY, et al. Paracetamol reduces postoperative pain and rescue analgesic demand after Robot-Assisted endoscopic thyroidectomy by the transaxillary approach. World J Surg, 2010, 34(3):521-526.
19.	Bleyer A, Viny A, Barr R. Cancer in 15 to 29-year-olds by primary site. Oncologist, 2006, 11(6):590-601.

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4):225-249.
2. Miccoli P, Materazzi G, Berti P. Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers:indications and limits. Curr Opin Otolaryngol Head Neck Surg, 2010, 18(2):114-118.
3. Miccoli P, Berti P, Raffaelli M, et al. Minimally invasive videoassisted thyroidectomy. Am J Surg, 2001, 181(6):567-570.
4. Ikeda Y, Takami H, Sasaki Y, et al. Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc, 2002, 16(12):1741-1745.
5. 王圣应, 朱正志, 彭德峰, 等.分化型甲状腺癌颈淋巴结转移规律的研究.中华外科杂志, 2008, 46(18):1404-1406.
6. Hüscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endosc, 1997, 11(8):877.
7. Miccoli P, Berti P, Conte M, et al. Minimally invasive surgery for thyroid small nodules:Preliminary report. J Endocrinol Invest, 1999, 22(11):849-851.
8. Kitano H, Fujimura M, Kinoshita T, et al. Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc, 2002, 16(1):88-91.
9. 王平.腔镜甲状腺癌根治术的现状与展望.外科理论与实践, 2011, 16(6):522-525.
10. 李志宇, 王平, 林信斌, 等.经胸乳人路内镜手术治疗甲状腺乳头状癌85例临床分析.中华普通外科杂志, 2011, 26(6):485-488.
11. 祝玉祥, 章佳新, 蔡凤林, 等.全腔镜手术与传统手术治疗早期分化型甲状腺癌的临床比较.中国普通外科杂志, 2014, 23(5):605-608.
12. 陈光, 吕智, 王培松, 等.改良Miccoli术式微创甲状腺癌根治术302例.中华腔镜外科杂志:电子版, 2013, 6(3):222-225.
13. 张伟, 仇明, 江道振, 等.完全腔镜与中转开放甲状腺癌根治术的比较.中国微创外科杂志, 2012, 12(1):33-35.
14. Kim JH, Choi YJ, Kim JA, et al. Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach. Surg Laparosc Endosc Percutan Tech, 2008, 18(2):197-201.
15. 于金玲, 任建强, 周予民, 等.经胸壁入路内镜甲状腺切除术与开放甲状腺切除术围手术期创伤因素的对比研究.腹腔镜外科杂志, 2010, 15(1):27-30.
16. 孙志刚, 陆涛, 卢榜裕, 等.腔镜与传统甲状腺手术对机体免疫功能的影响.中国微创外科杂志, 2009, 9(1):62-65.
17. Ikeda Y, Takami H, Sasaki Y, et al. Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg, 2003, 196(2):189-195.
18. Hong JY, Kim WO, Chung WY, et al. Paracetamol reduces postoperative pain and rescue analgesic demand after Robot-Assisted endoscopic thyroidectomy by the transaxillary approach. World J Surg, 2010, 34(3):521-526.
19. Bleyer A, Viny A, Barr R. Cancer in 15 to 29-year-olds by primary site. Oncologist, 2006, 11(6):590-601.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Comparative Study of Total Endoscopic, Endoscopic-Assisted, Open Thyroidectomy for cT1N0 Differentiated Thyroid Cancer

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