Jiang Bo, Qu Cheng, Jiang Chaoyu, Zhang Chen, Shen Song, Luo Yuqian, Su Lei
Department of General Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Front Oncol. 2022 Mar 15;12:842981. doi: 10.3389/fonc.2022.842981. eCollection 2022.
Various incisions and approaches for thyroidectomy have been developed to treat differentiated thyroid cancer (DTC). Supraclavicular oblique incision (SOI) thyroidectomy (SOIT) has been applied in DTC patients over the past ten years. However, the safety and efficacy of this approach were yet to be confirmed.
This study aimed to compare the surgical and patient-related outcomes between SOIT and traditional low collar incision thyroidectomy (TLCIT) in patients with DTC.
We retrospectively screened all patients with DTC who received thyroid lobectomy from October 2020 to October 2021. The surgical results and patient-related outcomes assessed at 1 and 6 months after surgery by questionnaire were compared between the SOIT and TLCIT groups.
A total of 128 patients were included in this study, of whom 38 patients (30.5%) were operated on with SOIT and 89 patients (69.5%) with TLCIT. There was no significant difference in demographic characteristics and thyroid features between the two groups. Despite comparable operative time (61.9 ± 12.1 vs. 59.9 ± 15.0 min, p = 0.425), the SOIT group had a smaller neck incision (4.4 ± 0.7 vs. 5.0 ± 1.0 cm, p = 0.002), a shorter duration of postoperative drainage (2.4 ± 0.5 vs. 2.7 ± 0.9 days, p = 0.019), less volume of postoperative drainage (48.4 ± 24.6 vs. 60.3 ± 22.8 ml, p = 0.040), and shorter postoperative hospitalization (3.2 ± 0.5 vs. 3.6 ± 0.9 days p = 0.006), as compared with the TLCIT group. At 1-month follow-up after surgery, SOIT showed better performance in preventing hypoparathyroidism (p = 0.026) and abnormal neck sensation (p = 0.010) and in improving cosmetic satisfaction (p = 0.036) than TLCIT. At 6-month follow-up, SOIT was feedback with better cosmetic satisfaction (p < 0.001) and a lower percent of abnormal neck sensation (p = 0.031) or movement (p = 0.005).
Our study suggests that minimally invasive surgery using the SOI provides superior surgical and patient-related outcomes compared with surgery using a traditional low collar incision (TLCI) in patients with DTC.
为治疗分化型甲状腺癌（DTC），已开发出多种甲状腺切除术的切口和入路。锁骨上斜切口（SOI）甲状腺切除术（SOIT）在过去十年中已应用于DTC患者。然而，这种方法的安全性和有效性尚待证实。
本研究旨在比较DTC患者中SOIT与传统低领切口甲状腺切除术（TLCIT）的手术及患者相关结局。
我们回顾性筛选了2020年10月至2021年10月期间接受甲状腺叶切除术的所有DTC患者。通过问卷调查比较了SOIT组和TLCIT组在术后1个月和6个月时评估的手术结果及患者相关结局。
本研究共纳入128例患者，其中38例（30.5%）接受了SOIT手术，89例（69.5%）接受了TLCIT手术。两组患者的人口统计学特征和甲状腺特征无显著差异。尽管手术时间相当（61.9±12.1 vs. 59.9±15.0分钟，p = 0.425），但SOIT组的颈部切口更小（4.4±0.7 vs. 5.0±1.0厘米，p = 0.002），术后引流持续时间更短（2.4±0.5 vs. 2.7±0.9天，p = 0.019），术后引流量更少（48.4±24.6 vs. 60.3±22.8毫升，p = 0.040），术后住院时间更短（3.2±0.5 vs. 3.6±0.9天，p = 0.006）。与TLCIT组相比，术后1个月随访时，SOIT在预防甲状旁腺功能减退（p = 0.026）和颈部感觉异常（p = 0.010）以及提高美容满意度（p = 0.036）方面表现更好。在6个月随访时，SOIT的美容满意度更高（p < 0.001），颈部感觉异常（p = 0.031）或活动异常（p = 0.005）的比例更低。
我们的研究表明，对于DTC患者，采用SOI的微创手术与采用传统低领切口（TLCI）的手术相比，在手术及患者相关结局方面具有优势。
