The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China.
Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China.
Surg Endosc. 2020 May;34(5):1891-1903. doi: 10.1007/s00464-019-07283-y. Epub 2020 Mar 6.
Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC).
Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis.
The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05).
The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.
尽管甲状腺手术已经朝着微创和内镜方法发展，但全内镜甲状腺切除术（TET）在甲状腺癌中的作用仍存在很大争议。我们进行了系统评价和荟萃分析，以评估 TET 与传统开放甲状腺切除术（COT）在治疗甲状腺乳头状癌（PTC）中的安全性和有效性。
系统检索了 PubMed、Embase、Cochrane 图书馆和 Web of science 等医学文献数据库，以获取自数据库建立以来至 2019 年 3 月比较 TET 和 COT 治疗 PTC 的文章。使用 Review Manager 软件 Stata V.13.0 评估纳入研究的质量，并采用 Downs 和 Black 量表进行评估。
本系统评价和荟萃分析基于 20 篇文献中选择的 5664 例患者。用于确定手术完整性的标准包括术后甲状腺球蛋白（TG）水平、长期随访后肿瘤复发。不良事件和并发症发生率评分包括暂时性喉返神经（RLN）麻痹、永久性 RLN 麻痹、暂时性低钙血症、永久性低钙血症、手术时间、切除淋巴结数量、住院时间和患者美容满意度。TET 在手术完整性和不良事件发生率方面通常与 COT 相当，尽管 TET 导致暂时性低钙血症水平较低（OR 1.66；p<0.05）、切除的淋巴结数量较少（WMD 0.46；p<0.05）和更好的美容满意度（WMD 1.73；p<0.05）。COT 与较短的手术时间相关（WMD-50.28；p<0.05）和暂时性 RLN 麻痹发生率较低（OR 0.41；p<0.05）。
结果表明，在安全性和疗效方面，TET 与 COT 治疗甲状腺癌相似。实际上，TET 的肿瘤复发率和手术完整性水平与 COT 相当。TET 与暂时性低钙血症水平显著降低和更好的美容满意度相关，因此是对美容有顾虑的患者的更好选择。总的来说，需要进行随机临床试验和具有更大患者队列和长期随访数据的研究，以进一步证明 TET 的价值。
