Mo Lin-Long, Meng Fan-Lun, Yang Zi-Quan, Hou Ling-Mi, Fang Fang
Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China.
Department of Thyroid & Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Transl Cancer Res. 2020 Apr;9(4):2865-2874. doi: 10.21037/tcr.2020.02.29.
Endoscopic thyroidectomy (ET) has been widely accepted as a surgical option for benign thyroid lesions, yet remains controversial in the treatment of malignant thyroid because of concerns with the safety and efficacies. This paper aims at systematically evaluating the advantages and disadvantages of ET in malignant thyroid tumors through meta-analyses.
Meta-analysis was conducted by retrieving all studies on the treatment of malignant thyroid carcinomas released in database, including PubMed, Web of Science, Cochrane and Google scholar, from January 2005 to January 2019. Then the safety and efficacies were compared between the two surgical modalities based on current reports.
Totally, 3,482 cases were included in 11 related studies. Most adverse outcomes by ET were involved in transient or permanent recurrent laryngeal nerve paralysis (RLN) and hypocalcemia, postoperative total complications, hemorrhage, hematoma at the incision, and total relapse rate following surgery. Besides, ET led to higher incidence of transient RLN palsy, yet significantly lower transient hypocalcemia than conventional open thyroidectomy (COT). The difference was insignificant regarding transient or permanent RLN and hypocalcemia, total postoperative complications, postoperative hemorrhage, incisional hematoma and total recurrent rate between the two procedures. Secondary outcomes consisted of operative time, hospital stay and cosmetic results, by which COT was superior to ET, yet cosmetic incision was better by ET than by COT. There was no significant difference in hospital stay.
ET can be feasible and safe surgical option for malignant thyroid lesions, with better cosmetic effect.
内镜甲状腺切除术（ET）已被广泛接受为良性甲状腺病变的一种手术选择，但由于对安全性和有效性的担忧，在甲状腺恶性肿瘤的治疗中仍存在争议。本文旨在通过荟萃分析系统评估ET在甲状腺恶性肿瘤治疗中的优缺点。
通过检索2005年1月至2019年1月期间在数据库（包括PubMed、Web of Science、Cochrane和谷歌学术）中发布的所有关于甲状腺癌治疗的研究进行荟萃分析。然后根据当前报告比较两种手术方式的安全性和有效性。
11项相关研究共纳入3482例病例。ET的大多数不良结局包括短暂性或永久性喉返神经麻痹（RLN）和低钙血症、术后总并发症、出血、切口血肿以及术后总复发率。此外，ET导致短暂性RLN麻痹的发生率较高，但短暂性低钙血症的发生率明显低于传统开放性甲状腺切除术（COT）。两种手术方式在短暂性或永久性RLN和低钙血症、术后总并发症、术后出血、切口血肿和总复发率方面的差异无统计学意义。次要结局包括手术时间、住院时间和美容效果，COT在这些方面优于ET，但ET的美容切口比COT更好。住院时间无显著差异。
ET对于甲状腺恶性病变可以是一种可行且安全的手术选择，具有更好的美容效果。
