Li Yujun, Liu Zhaodi, Song Zhuolin, Wang Yong, Yu Xing, Wang Ping
Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China.
Front Oncol. 2023 Feb 28;13:1081835. doi: 10.3389/fonc.2023.1081835. eCollection 2023.
The endoscopic thyroidectomy areola approach (ETAA) is widely used in patients with benign thyroid tumors and papillary thyroid microcarcinoma (PTMC). Its safety and complication rates are reported to be similar to open thyroidectomy (OT). This study aimed to evaluate the safety and feasibility of ETAA, compared with OT, in patients with papillary thyroid non-microcarcinoma (PTNMC).
We retrospectively reviewed all patients with PTNMC who underwent ETAA or OT in our hospital from January 2017 to December 2021. A total of 302 patients were matched at a ratio of 1:1 by the propensity score matching (PSM) analysis and surgical outcomes. Safety and feasibility were analyzed between two groups.
Before PSM, patients in the ETAA group were younger ( < 0.001) and had a larger proportion of female patients ( < 0.001) with a lower BMI ( < 0.001) compared with the OT group. The ETAA group also had a higher proportion of unilateral thyroidectomy ( = 0.002). PSM was used to create a highly comparable control group. After PSM, the ETAA group had a longer operative time ( < 0.001), larger blood loss ( = 0.046) and total drainage amount ( = 0.035), with higher C-reactive protein ( = 0.023) and better cosmetic outcomes ( < 0.001). There were no significant differences in the following clinicopathologic characteristics: number of dissected positive lymph nodes, rate of recurrent laryngeal nerve signal weakened, parathyroid autotransplantation, postoperative pain, hospital stay, complications, and oncologic completeness. There was no patient converted to OT in the ETAA group and two patients suffered from persistence/recurrence in the follow-up.
ETAA is a safe and feasible surgical approach for patients with PTNMC.
内镜甲状腺切除术乳晕入路（ETAA）广泛应用于良性甲状腺肿瘤和甲状腺微小乳头状癌（PTMC）患者。据报道，其安全性和并发症发生率与开放性甲状腺切除术（OT）相似。本研究旨在评估与OT相比，ETAA在甲状腺非微小乳头状癌（PTNMC）患者中的安全性和可行性。
我们回顾性分析了2017年1月至2021年12月在我院接受ETAA或OT的所有PTNMC患者。通过倾向评分匹配（PSM）分析和手术结果，以1:1的比例匹配了总共302例患者，并对两组之间的安全性和可行性进行了分析。
在PSM之前，与OT组相比，ETAA组患者更年轻（<0.001），女性患者比例更高（<0.001），BMI更低（<0.001）。ETAA组单侧甲状腺切除术的比例也更高（=0.002）。使用PSM创建了一个高度可比的对照组。PSM后，ETAA组的手术时间更长（<0.001），失血量更大（=0.046）和总引流量更多（=0.035），C反应蛋白水平更高（=0.023），美容效果更好（<0.001）。在以下临床病理特征方面无显著差异：清扫阳性淋巴结数量、喉返神经信号减弱率、甲状旁腺自体移植、术后疼痛、住院时间、并发症和肿瘤学完整性。ETAA组无患者转为OT，随访中有2例患者出现持续性/复发性疾病。
ETAA是PTNMC患者一种安全可行的手术方法。
