Del Rio Paolo, Maestroni Umberto, Sianesi Mario, Viani Lorenzo, Vicente Diego, Stojadinovic Alexander, Avital Itzhak
Department of Surgery, University Hospital of Parma, Parma - Italy.
Tumori. 2015 Mar-Apr;101(2):144-7. doi: 10.5301/tj.5000223. Epub 2015 Mar 16.
Minimally invasive video-assisted thyroidectomy (MIVAT) was initially introduced for the treatment of selected patients who met certain thyroid volume, nodule size and pathological criteria. Recent studies indicate that the completeness of resection of malignant nodules is comparable to that obtained with conventional thyroidectomy.
To compare the 5-year outcomes in patients with papillary thyroid carcinoma (PTC) treated with MIVAT versus conventional thyroidectomy.
In this prospective cohort study conducted over 2 years (July 2005-June 2007), 172 patients with node-negative, nonmetastatic PTC underwent either MIVAT (n = 67) or conventional thyroidectomy (n = 105). Study outcomes were 1) the cumulative dose of radioactive iodine (RAI) to achieve a disease-free state, defined as a stimulated serum thyroglobulin (Tg) level <2 ng/mL with negative Tg antibody and no tumor on a whole-body scan or cross-sectional imaging, and 2) the 5-year serum Tg level.
The clinical parameters of the MIVAT and conventional thyroidectomy groups were comparable except for age (mean 43 ± 12 vs. 59 ± 17 years, respectively; p = 0.03) and operative time (mean 69 ± 24 vs. 53 ± 16 minutes, p = 0.02); the mean tumor size was similar between groups (1.3 ± 0.7 vs. 1.6 ± 0.9 cm, p = 0.14). Surgical morbidity was similar in both groups. Median follow-up was 5 years. RAI dose (mean 72 ± 38 vs. 96 ± 47 mCu, p = 0.34) and serum Tg at 5 years (mean 0.3 ± 0.2 vs. 0.5 ± 0.3 ng/mL, p = 0.30) were not significantly different between the MIVAT and conventional thyroidectomy groups.
MIVAT can be safely utilized in patients with localized PTC, providing comparable completeness of resection and oncological outcome to conventional thyroidectomy.
微创视频辅助甲状腺切除术（MIVAT）最初用于治疗符合特定甲状腺体积、结节大小和病理标准的特定患者。近期研究表明，恶性结节的切除完整性与传统甲状腺切除术相当。
比较接受MIVAT与传统甲状腺切除术治疗的甲状腺乳头状癌（PTC）患者的5年预后。
在这项为期2年（2005年7月至2007年6月）的前瞻性队列研究中，172例无淋巴结转移、非转移性PTC患者接受了MIVAT（n = 67）或传统甲状腺切除术（n = 105）。研究结局为：1）达到无病状态所需的放射性碘（RAI）累积剂量，定义为刺激后的血清甲状腺球蛋白（Tg）水平<2 ng/mL、Tg抗体阴性且全身扫描或横断面成像未发现肿瘤；2）5年血清Tg水平。
MIVAT组和传统甲状腺切除术组的临床参数具有可比性，但年龄（分别为43±12岁和59±17岁；p = 0.03）和手术时间（分别为69±24分钟和53±16分钟，p = 0.02）除外；两组的平均肿瘤大小相似（1.3±0.7 cm和1.6±0.9 cm，p = 0.14）。两组的手术并发症相似。中位随访时间为5年。MIVAT组和传统甲状腺切除术组之间的RAI剂量（分别为72±38和96±47 mCi，p = 0.34）和5年时的血清Tg水平（分别为0.3±0.2和0.5±0.3 ng/mL，p = 0.30）无显著差异。
MIVAT可安全用于局限性PTC患者，其切除完整性和肿瘤学结局与传统甲状腺切除术相当。
