Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
JAMA Otolaryngol Head Neck Surg. 2015 Jun;141(6):512-8. doi: 10.1001/jamaoto.2015.0596.
Reoperation for recurrent papillary thyroid cancer (PTC) can be associated with a high rate of complications and failure to provide lasting remission. Percutaneous ethanol injection (PEI) may be an effective nonsurgical management option for locally recurrent PTC.
This systematic analysis of the current literature compares the efficacy and complications related to PEI vs reoperative surgical intervention for treatment of locally recurrent PTC.
Original studies were identified using the keywords "thyroid/ethanol" and "recurrent thyroid cancer/repeat surgery."
Studies evaluating reoperation or PEI for lymph node metastases in patients with primary surgery of total thyroidectomy with appropriate lymph node dissection where indicated were included in the analysis for both reoperation and PEI. Animal studies, single case reports, and studies with fewer than 10 lesions were excluded.
Outcomes included interval to detection of recurrence, success and failure rates, recurrence rates, complication rates, and follow-up duration. Between-group outcome differences were calculated using random-effects models, and pooled data cross-tabulation and logistic regression analysis were used.
In all, 945 publications were identified, and 27 studies met the inclusion criteria. There were no studies that directly compared the 2 treatment techniques. A total of 1617 patients were included in this analysis; 168 (11.4%) were treated with PEI, and 1449 (88.6%) were treated with reoperation. Reoperation was successful in 94.8% of cases compared with an 87.5% success rate for PEI (odds ratio [OR], 2.58; 95% CI, 1.55-4.31; P < .001). The recurrence rates for PEI and reoperation at the site of the treated lesion or elsewhere in the neck were also similar (OR, 1.07; 95% CI, 0.65-1.77; P = .78). Reoperation was associated with a 3.5% pooled risk of complications, while PEI incurred a pooled risk of 1.2% (OR, 2.9; 95% CI, 0.72-12.3; P = .08). However, most studies did not report routine preoperative and postoperative laryngoscopies, an evaluation needed for accurate neural complication analysis associated with each procedure.
High-quality, well-designed studies are needed to evaluate the feasibility of incorporating PEI into the treatment protocol of PTC. Although presently inferior to reoperation, PEI has the potential to be a widely accepted and effective nonsurgical treatment option for limited recurrent PTC in poor surgical candidates or patients seeking to avoid multiple reoperations.
复发性甲状腺乳头状癌 (PTC) 的再次手术可能会伴随高并发症发生率和无法持久缓解的风险。经皮乙醇注射 (PEI) 可能是一种有效的局部复发性 PTC 非手术治疗选择。
本系统分析当前文献比较了 PEI 与再次手术干预治疗局部复发性 PTC 的疗效和并发症。
使用关键字“thyroid/ethanol”和“recurrent thyroid cancer/repeat surgery”，通过原始研究确定。
纳入分析的研究包括对接受过全甲状腺切除术和适当淋巴结清扫术的患者进行的针对淋巴结转移的再次手术或 PEI 治疗，其中包括原发手术。排除了动物研究、单一病例报告和病变少于 10 个的研究。
结果包括复发检测的时间间隔、成功率和失败率、复发率、并发症发生率和随访时间。使用随机效应模型计算组间结果差异，并使用交叉表和逻辑回归分析进行汇总数据。
共确定了 945 篇出版物，其中 27 项研究符合纳入标准。没有直接比较两种治疗技术的研究。共有 1617 名患者纳入本分析；168 名（11.4%）接受了 PEI 治疗，1449 名（88.6%）接受了再次手术治疗。再次手术成功率为 94.8%，而 PEI 的成功率为 87.5%（比值比 [OR]，2.58；95%置信区间 [CI]，1.55-4.31；P<.001）。PEI 和再次手术在治疗病变部位或颈部其他部位的复发率也相似（OR，1.07；95%CI，0.65-1.77；P=.78）。再次手术的并发症总风险为 3.5%，而 PEI 的并发症总风险为 1.2%（OR，2.9；95%CI，0.72-12.3；P=.08）。然而，大多数研究并未报告常规术前和术后喉镜检查，这是准确分析每种手术相关神经并发症所必需的。
需要高质量、精心设计的研究来评估将 PEI 纳入 PTC 治疗方案的可行性。虽然目前逊于再次手术，但 PEI 有可能成为一种广泛接受且有效的非手术治疗选择，适用于手术条件差的局限性复发性 PTC 患者或希望避免多次手术的患者。
