Department of Oncology, Hanoi Medical University, No 1 Ton That Tung Street, Dong Da District, Hanoi, Viet Nam.
Department of Oncology and Palliative Care, Hanoi Medical University Hospital, No 1 Ton That Tung Street, Dong Da District, Hanoi, 100000, Viet Nam.
Surg Endosc. 2022 Jun;36(6):4248-4254. doi: 10.1007/s00464-021-08759-6. Epub 2021 Oct 7.
The transoral endoscopic thyroidectomy by vestibular approach (TOETVA) has been developed for early-stage thyroid cancer treatment as well as benign thyroid nodules worldwide including Viet Nam, with low rate of complications and excellent results. However, there has not been any comprehensive studies with a large number of patients and long-term follow-up in our country. Therefore, we conducted this study to evaluate the results of treatment by TOETVA for benign and malignant lesions of thyroid gland in Viet Nam.
A prospective study was performed on 326 eligible patients who underwent TOETVA due to thyroid cancer and benign thyroid nodules in Department of Oncology and Palliative Care, Hanoi Medical University Hospital from July 2018 to April 2021. The clinical, surgical, and pathological characteristics, postoperative complications, and visual analog scale (VAS, 0-10 cm) score in day 1, 4, and 7 after surgery, long-term oncological and surgical outcomes were recorded.
The mean age was 36.9 ± 9.8 years. 231 patients (70.9%) were diagnosed with differentiated cancer and 95 patients (29.1%) were diagnosed benign tumors of thyroid gland. In the cancer group, 12 patients (5.2%) undergone TOETVA had T3b-intraoperative-stage diagnosis, 219 patients (92.2%) were diagnosed T1 according to AJCC 8th. After 1 month of surgery, among thyroid cancer patients, there was no abnormality reported by thyroid scintigraphy and neck ultrasound as well as in unstimulated-Tg and anti-Tg values. The mean number lymph-node dissected in the cancer group was 6.1 ± 4.1 (range 0-21 nodes). However, only 2.6 ± 1.8 metastasis nodes were discovered (range 1-8 nodes), and the maximum size of these nodes was less than 2 mm. 81 patients presented occult lymph-node metastasis among thyroid cancer patients with cN0 stage (account for 35%). The occult lymph-node metastasis was 34.2% and 50% in patients diagnosed with T1 and T3b groups, respectively. The median postoperative hospital stay was 5.4 ± 0.7 days. Postoperatively, transient hypoparathyroidism was recorded in 12 patients (4.8%), transient hoarse was noted in 9 patients (3.6%), and numb chin was identified in 7 patients (2.8%). No permanent complication was noted. VAS score on first postoperative day was 4.5 ± 0.8. Median follow-up time was 12 (3-25) months. No recurrence was recorded.
TOETVA is an innovative and revolutionary technique in the treatment of benign thyroid nodules, as well as early-stage differentiated thyroid cancer. The results of oncology, postoperative complications, and satisfied outcomes supported the wide application of TOETVA in Viet Nam.
经口内镜甲状腺手术（TOETVA）经前庭入路已在全世界范围内用于治疗早期甲状腺癌以及良性甲状腺结节，具有较低的并发症发生率和良好的效果。然而，在我国尚未有任何针对大量患者和长期随访的综合研究。因此，我们进行了这项研究，以评估 TOETVA 在治疗越南甲状腺良恶性病变方面的结果。
对 2018 年 7 月至 2021 年 4 月期间在河内医科大学附属医院肿瘤与姑息治疗科因甲状腺癌和良性甲状腺结节而行 TOETVA 的 326 例合格患者进行前瞻性研究。记录临床、手术和病理特征、术后并发症以及术后第 1、4 和 7 天的视觉模拟量表（VAS，0-10cm）评分、长期肿瘤学和手术结果。
患者平均年龄为 36.9±9.8 岁。231 例（70.9%）诊断为分化型癌，95 例（29.1%）诊断为甲状腺良性肿瘤。在癌症组中，12 例（5.2%）TOETVA 术中诊断为 T3b 期，219 例（92.2%）根据第 8 版 AJCC 诊断为 T1。术后 1 个月，甲状腺癌患者的甲状腺闪烁扫描和颈部超声以及未刺激的甲状腺球蛋白（Tg）和抗甲状腺球蛋白（TgAb）值均未见异常。癌症组中平均淋巴结清扫数目为 6.1±4.1（范围 0-21 个）。然而，仅发现 2.6±1.8 个转移淋巴结（范围 1-8 个），这些淋巴结的最大直径均小于 2mm。81 例甲状腺癌 cN0 期患者存在隐匿性淋巴结转移（占 35%）。隐匿性淋巴结转移在 T1 组和 T3b 组患者中的比例分别为 34.2%和 50%。中位术后住院时间为 5.4±0.7 天。术后，12 例（4.8%）出现短暂甲状旁腺功能减退，9 例（3.6%）出现短暂声音嘶哑，7 例（2.8%）出现颏部麻木。无永久性并发症。术后第 1 天的 VAS 评分为 4.5±0.8。中位随访时间为 12（3-25）个月。未发现复发。
TOETVA 是一种创新性和革命性的技术，可用于治疗良性甲状腺结节以及早期分化型甲状腺癌。肿瘤学结果、术后并发症和满意的结果支持在越南广泛应用 TOETVA。
