Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China.
J Surg Oncol. 2023 Sep;128(4):502-509. doi: 10.1002/jso.27360. Epub 2023 Jun 11.
Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has become increasingly popular in the treatment of papillary thyroid cancer (PTC). This study aimed to describe the safety and feasibility of total thyroidectomy between the TOETVA and open thyroidectomy (OT) approaches for the treatment of patients with PTC.
We retrospectively reviewed 780 consecutive patients suffering from PTC that had undergone total thyroidectomy using TOETVA (n = 107) and OT (n = 673) between April 2016 and December 2021 at our institute. Afterward, a total of 101 matched patients' surgical outcomes were compared using propensity score matching (PSM) analysis.
Before PSM, the patients in the TOETVA group were younger (p < 0.001), had a lower body mass index (p < 0.001) and a greater female population (p < 0.001). After PSM, the TOETVA group was associated with significantly longer operative time (p < 0.001), greater blood loss (p < 0.001), total drainage amount (p < 0.001), higher C-reaction protein level (p < 0.001), better cosmetic satisfaction (p < 0.001) and quality of life (p < 0.001) and lower scar self-consciousness (p < 0.001). There was no statistical difference between the groups in the rate of parathyroid autotransplantation and bilateral lymph node dissection, the positivity of lymph node metastasis, number of dissected lymph nodes and positive lymph nodes, multifocality, postoperative level of blood calcium and parathyroid hormone (PTH), rate of PTH < 15 ng/mL, visual analog scale score, duration of hospital stay, complications, mean thyroid stimulating hormone (TSH)-stimulated Tg level before radioactive iodine, mean Tg level without TSH stimulation, and the proportion of serum Tg level of <1.
TOETVA is a safe and feasible technique for better cosmetic effects and similar surgical outcomes compared to conventional open surgery for the studied patients that required total thyroidectomy.
经口内镜甲状腺手术（TOETVA）经前庭入路已在甲状腺乳头状癌（PTC）的治疗中变得越来越流行。本研究旨在描述经口内镜甲状腺手术（TOETVA）和开放性甲状腺切除术（OT）在治疗 PTC 患者时行甲状腺全切除术的安全性和可行性。
我们回顾性分析了 2016 年 4 月至 2021 年 12 月期间，在我们医院接受 TOETVA（n=107）和 OT（n=673）治疗的 780 例连续 PTC 患者的资料。然后，通过倾向评分匹配（PSM）分析比较了 101 例匹配患者的手术结果。
在 PSM 之前，TOETVA 组患者更年轻（p<0.001），体重指数更低（p<0.001），女性患者更多（p<0.001）。PSM 后，TOETVA 组手术时间更长（p<0.001），术中出血量更多（p<0.001），总引流量更多（p<0.001），C 反应蛋白水平更高（p<0.001），美容满意度更好（p<0.001），生活质量更高（p<0.001），疤痕自觉意识更低（p<0.001）。两组甲状旁腺自体移植率、双侧淋巴结清扫率、淋巴结转移阳性率、淋巴结清扫数量和阳性淋巴结数量、多发病灶、术后血钙和甲状旁腺激素（PTH）水平、PTH<15ng/ml 率、视觉模拟评分、住院时间、并发症、放射性碘治疗前促甲状腺激素（TSH）刺激 Tg 水平的平均值、无 TSH 刺激时 Tg 水平的平均值以及血清 Tg 水平<1 的比例均无统计学差异。
与传统的开放性手术相比，TOETVA 是一种安全可行的技术，可获得更好的美容效果和相似的手术结果，适用于需要行甲状腺全切除术的研究患者。
