Comparison of Effectiveness and Safety Between Minimally Invasive Video-Assisted Thyroidectomy and Conventional Open Thyroidectomy in The Treatment of Thyroid Carcinoma Without Lymph Node Metastasis: A Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUJiang-hao ¹ , ZHANGLei ¹ , LIGang ² , ZHANGChang-ming ³ ,  LUOJun ¹

1. 1.Department of Vasular and Thyroid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China;
2. 2.Department of General Surgery, Mingyuan Staff-Worker Hospital, Urumqi 830000, Xinjiang Uygur Autonomous Region, China;
3. 3.Department of Chest Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China;

Corresponding author：

LUOJun, Email: 402454962@qq.com

Keywords：

Thyroid carcinoma without lymph node metastasis; Minimally invasive video-assisted thyroidectomy; Conventional open thyroidectomy; Effectiveness; Safety; Meta-analysis

DOI：

10.7507/1007-9424.20160180

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Objective To systematically evaluate the effectiveness and safety of minimally invasive video-assisted thyroidectomy (MIVAT) and conventional open thyroidectomy (COT) in treatment of thyroid carcinoma without lymph node metastasis. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), WanFang, CBM, VIP and CNKI were searched to collect the randomized controlled trails (RCTs) and non-RCTs about MIVAT and COT in treatment of thyroid carcinoma without lymph node metastasis. The retrieval time was from inception to October 2015. The studies were screened according to the inclusion and exclusion criterias, and the data was extracted and the quality of studies was evaluated by 2 reviewers independently. Then the Meta-analysis was conducted by using RevMan 5.2 software. Results A total of 13 non-RCTs involving 3 083 cases were included. The results of Meta-analysis showed that: compared with COT group, operative time of MIVAT group was longer (MD=31.36, 95% CI: 27.68-35.03, P<0.05), hospital stay (MD=-0.16, 95% CI: -0.28--0.04, P=0.01) and length of scar (MD=-1.51, 95% CI: -1.63--1.39, P<0.05) of MIVAT group were shorter, but there was no significant difference in the incidences of transient hypocalcemia (OR=1.29, 95% CI: 0.93-1.78, P=0.13), transient laryngeal nerve palsy (OR=1.42, 95% CI: 0.93-2.17, P=0.11), hemotoma (OR=1.21, 95% CI: 0.64-2.29, P=0.56), recurrence (OR=0.61, 95% CI: 0.28-1.33, P=0.22), number of retrieved central lymph nodes (MD=-0.10, 95% CI: -0.98-0.78, P=0.82), and the size of tumors (MD=-0.02, 95% CI: -0.06-0.02, P=0.39) between the 2 groups. Conclusion MIVAT is safe and feasible in treatment of thyroid carcinoma without lymph node metastasis when its indications are strictly controlled.

Citation： LIUJiang-hao, ZHANGLei, LIGang, ZHANGChang-ming, LUOJun. Comparison of Effectiveness and Safety Between Minimally Invasive Video-Assisted Thyroidectomy and Conventional Open Thyroidectomy in The Treatment of Thyroid Carcinoma Without Lymph Node Metastasis: A Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 667-675. doi: 10.7507/1007-9424.20160180 Copy

1.	Yang L, Shen W, Sakamoto N. Population-based study evaluating and predicting the probability of death resulting from thyroid cancer and other causes among patients with thyroid cancer. J Clin Oncol, 2013, 31(4): 468-474.
2.	Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract, 2010, 16(3): 468-475.
3.	Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol, 2006, 154(6): 787-803.
4.	Fengler TW. Endoscopic right thyroid lobectomy. Freshw Biol, 1997, 11(8): 878-879.
5.	Miccoli P, Elisei R, Materazzi G, et al. Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery, 2002, 132(6): 1070-1074.
6.	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.
7.	Ng WT. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech, 2000, 10(5): 339-340.
8.	Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic neck surgery by the axillary approach. J Am Coll Surg, 2000, 191(3): 336-340.
9.	Gagner M, Inabnet WB 3rd. Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid, 2001, 11(2): 161-163.
10.	Shimazu K, Shiba E, Tamaki Y, et al. Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech, 2003, 13(3): 196-201.
11.	Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Appl Eng Agric, 2002, 18(6): 727-734.
12.	Lombardi CP, Raffaelli M, de Crea CA, et al. Video-assisted versus conventional total thyroidectomy and central compartment neck dissection for papillary thyroid carcinoma. World J Surg, 2012, 36(6): 1225-1230.
13.	Di JZ, Zhang HW, Han XD, et al. Minimally invasive video-assisted thyroidectomy for accidental papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy with 5 years follow-up. Chin Med J, 2011, 124(20): 3293-3296.
14.	Jeong JJ, Kang SW, Yun JS, et al. Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J Surg Oncol, 2009, 100(6): 477-480.
15.	Tae K, Ji YB, Cho SH, et al. Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy. Surg Laparosc Endosc Percutan Tech, 2011, 21(3): 162-169.
16.	Cho MJ, Park KS, Cho MJ, et al. A comparative analysis of endos-copic thyroidectomy versus conventional thyroidectomy in clinically lymph node negative thyroid cancer. Ann Surg Treat Res, 2015, 88 (2): 69-76.
17.	Miccoli P, Berti P, Raffaelli M, et al. Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidec-tomy: a prospective randomized study. Surgery, 2001, 130(6): 1039-1043.
18.	Lee SG, Lee J, Kim MJ, et al. Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study. Surg Endosc, 2015, [Epub ahead of print].
19.	Kim SK, Kang SY, Youn HJ, et al. Comparison of conventional thyroidectomy and endoscopic thyroidectomy via axillo-bilateral breast approach in papillary thyroid carcinoma patients. Surg Endosc, 2015, [Epub ahead of print].
20.	Bokor T, Kiffner E, Kotrikova B, et al. Cosmesis and body image after minimally invasive or open thyroid surgery. World J Surg, 2012, 36(6): 1279-1285.
21.	Chao TC, Lin JD, Chen MF. Video-assisted open thyroid lobectomy through a small incision. Surg Laparosc Endosc Percutan Tech, 2004, 14(1): 15-19.
22.	Chung YS, Choe JH, Kang KH, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg, 2007, 31(12): 2302-2308.
23.	Fík Z, Astl J, Zábrodsky M, et al. Minimally invasive video-assisted versus minimally invasive nonendoscopic thyroidectomy. Biomed Res Int, 2014, 2014: 450170.
24.	Tan Z, Gu J, Han Q, et al. Comparison of conventional open thyroi-dectomy and endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma. Int J Endocrinol, 2015, 2015: 239610.
25.	Dionigi G, Boni L, Rovera F, et al. Wound morbidity in mini-invasive thyroidectomy. Surg Endosc, 2011, 25(1): 62-67.
26.	Duh QY. Presidential address: minimally invasive endocrine surgery—standard of treatment or hype?. Surgery, 2003, 134(6): 849-857.

1. Yang L, Shen W, Sakamoto N. Population-based study evaluating and predicting the probability of death resulting from thyroid cancer and other causes among patients with thyroid cancer. J Clin Oncol, 2013, 31(4): 468-474.
2. Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract, 2010, 16(3): 468-475.
3. Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol, 2006, 154(6): 787-803.
4. Fengler TW. Endoscopic right thyroid lobectomy. Freshw Biol, 1997, 11(8): 878-879.
5. Miccoli P, Elisei R, Materazzi G, et al. Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery, 2002, 132(6): 1070-1074.
6. 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.
7. Ng WT. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech, 2000, 10(5): 339-340.
8. Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic neck surgery by the axillary approach. J Am Coll Surg, 2000, 191(3): 336-340.
9. Gagner M, Inabnet WB 3rd. Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid, 2001, 11(2): 161-163.
10. Shimazu K, Shiba E, Tamaki Y, et al. Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech, 2003, 13(3): 196-201.
11. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Appl Eng Agric, 2002, 18(6): 727-734.
12. Lombardi CP, Raffaelli M, de Crea CA, et al. Video-assisted versus conventional total thyroidectomy and central compartment neck dissection for papillary thyroid carcinoma. World J Surg, 2012, 36(6): 1225-1230.
13. Di JZ, Zhang HW, Han XD, et al. Minimally invasive video-assisted thyroidectomy for accidental papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy with 5 years follow-up. Chin Med J, 2011, 124(20): 3293-3296.
14. Jeong JJ, Kang SW, Yun JS, et al. Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J Surg Oncol, 2009, 100(6): 477-480.
15. Tae K, Ji YB, Cho SH, et al. Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy. Surg Laparosc Endosc Percutan Tech, 2011, 21(3): 162-169.
16. Cho MJ, Park KS, Cho MJ, et al. A comparative analysis of endos-copic thyroidectomy versus conventional thyroidectomy in clinically lymph node negative thyroid cancer. Ann Surg Treat Res, 2015, 88 (2): 69-76.
17. Miccoli P, Berti P, Raffaelli M, et al. Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidec-tomy: a prospective randomized study. Surgery, 2001, 130(6): 1039-1043.
18. Lee SG, Lee J, Kim MJ, et al. Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study. Surg Endosc, 2015, [Epub ahead of print].
19. Kim SK, Kang SY, Youn HJ, et al. Comparison of conventional thyroidectomy and endoscopic thyroidectomy via axillo-bilateral breast approach in papillary thyroid carcinoma patients. Surg Endosc, 2015, [Epub ahead of print].
20. Bokor T, Kiffner E, Kotrikova B, et al. Cosmesis and body image after minimally invasive or open thyroid surgery. World J Surg, 2012, 36(6): 1279-1285.
21. Chao TC, Lin JD, Chen MF. Video-assisted open thyroid lobectomy through a small incision. Surg Laparosc Endosc Percutan Tech, 2004, 14(1): 15-19.
22. Chung YS, Choe JH, Kang KH, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg, 2007, 31(12): 2302-2308.
23. Fík Z, Astl J, Zábrodsky M, et al. Minimally invasive video-assisted versus minimally invasive nonendoscopic thyroidectomy. Biomed Res Int, 2014, 2014: 450170.
24. Tan Z, Gu J, Han Q, et al. Comparison of conventional open thyroi-dectomy and endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma. Int J Endocrinol, 2015, 2015: 239610.
25. Dionigi G, Boni L, Rovera F, et al. Wound morbidity in mini-invasive thyroidectomy. Surg Endosc, 2011, 25(1): 62-67.
26. Duh QY. Presidential address: minimally invasive endocrine surgery—standard of treatment or hype?. Surgery, 2003, 134(6): 849-857.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Effectiveness and Safety Between Minimally Invasive Video-Assisted Thyroidectomy and Conventional Open Thyroidectomy in The Treatment of Thyroid Carcinoma Without Lymph Node Metastasis: A Meta-Analysis

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