Department of Minimally Invasive Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of TCM), Guangzhou, 510120, People's Republic of China.
Surg Endosc. 2022 Dec;36(12):9092-9098. doi: 10.1007/s00464-022-09376-7. Epub 2022 Jun 22.
Recent years there have been witnessed considerable advances in endoscopic selective lateral neck dissection (LND). However, dissection of lymph nodes at level IV and level VI via the chest approach is inherently challenging. In this study, we used combined trans-oral and chest approach for endoscopic thyroidectomy in patients with cT1-2N1bM0 papillary thyroid carcinoma (PTC).
Clinical characteristics and surgical outcomes of ten patients with cT1-2N1bM0 PTC who underwent endoscopic thyroidectomy via combination of trans-oral and chest approach between September 2020 and September 2021 were retrospectively reviewed.
All 10 patients successfully underwent total thyroidectomy and selective LND via chest approach, while central neck dissection (CND) and supplementary dissection of lymph nodes at level IV were performed via the trans-oral approach. The mean number of positive/retrieved level II, III-IV, and VI lymph nodes were 0.6 ± 1.0/9.8 ± 5.0, 4.6 ± 2.8/23.1 ± 4.7, and 4.9 ± 3.4/10.3 ± 4.6, respectively. Four patients developed transient hypoparathyroidism which spontaneously resolved within 1 month. Five patients developed numbness of lateral neck and ear and one patient experienced limb lift restriction. No other complications or tumor recurrence occurred during follow-up.
It is feasible to perform total thyroidectomy, CND, and selective LND via combined trans-oral and chest approach, and satisfactory short-term outcomes were observed in this cohort. This approach may offer one more option for cT1-2N1bM0 PTC patients, especially those in whom metastatic lymph nodes at level IV or level VI are detected by preoperative examination.
近年来，内镜选择性侧颈部淋巴结清扫术（LND）取得了相当大的进展。然而，经胸途径对 IV 级和 VI 级淋巴结的解剖具有固有挑战性。在这项研究中，我们使用经口和经胸联合入路对 cT1-2N1bM0 甲状腺乳头状癌（PTC）患者进行内镜甲状腺切除术。
回顾性分析 2020 年 9 月至 2021 年 9 月期间，10 例 cT1-2N1bM0 PTC 患者接受经口和经胸联合入路内镜甲状腺切除术的临床特征和手术结果。
所有 10 例患者均成功完成全甲状腺切除术和选择性经胸 LND，而中央颈部清扫术（CND）和 IV 级淋巴结的补充清扫则通过经口途径进行。阳性/检出的 II 级、III-IV 级和 VI 级淋巴结的平均数量分别为 0.6±1.0/9.8±5.0、4.6±2.8/23.1±4.7 和 4.9±3.4/10.3±4.6。4 例患者发生一过性甲状旁腺功能减退，1 个月内自行缓解。5 例患者出现颈侧和耳部麻木，1 例患者出现肢体抬举受限。随访期间无其他并发症或肿瘤复发。
经口和经胸联合入路行全甲状腺切除术、CND 和选择性 LND 是可行的，该队列观察到了满意的短期结果。对于 cT1-2N1bM0 PTC 患者，特别是术前检查发现 IV 级或 VI 级淋巴结转移的患者，这种方法可能提供了另一种选择。
