Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China.
Department of Health Care, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China.
Ann Surg Oncol. 2024 Mar;31(3):1498-1508. doi: 10.1245/s10434-023-14639-1. Epub 2023 Dec 15.
The technical difficulties and trauma of remote access methods in endoscopic surgery (ES) for lateral neck dissection (LND) can be daunting for most patients with papillary thyroid cancer (PTC) and surgeons. The purpose of study was to introduce gasless single-incision ES via a subclavicular approach (ESSA) and to explore its safety and efficacy for LND.
Between January 2022 and February 2023, we retrospectively reviewed 17 patients with PTC who underwent ESSA for LND. In addition, 22 patients who received video-assisted ES (VAES) and 48 patients who underwent open surgery (OP) for LND during the same period were included. Clinicopathological characteristics, complications, and efficacy of the lymph node yield (LNY) were compared between the ESSA and the other two groups (VAES and OP).
The LNY from central and lateral neck dissection by ESSA was comparable to that by VAES (9.2 ± 8.1 vs. 9.5 ± 4.2, P = 0.986, and 33.5 ± 11.6 vs. 30.6 ± 9.2, P = 0.382, respectively) and OP (9.2 ± 8.1 vs. 11.0 ± 5.4, P = 0.420, and 33.5 ± 11.6 vs. 31.5 ± 7.9, P = 0.383, respectively). Swallowing impairment scores at 1 and 3 months were significantly lower after ESSA than those after VAES (1.8 ± 1.0 vs. 3.0 ± 1.2, P = 0.003, and 0.9 ± 0.8 vs. 1.7 ± 0.8, P = 0.006, respectively). The cosmetic satisfaction rate 1 month after surgery was significantly higher in the ESSA group than that in the VAES group (100 vs. 31.8%, P < 0.001).
ESSA is a safe and minimally invasive procedure that provides a scarless cervical appearance and has good efficacy for LND. Therefore, ESSA may be a feasible choice for selected patients with N1b PTC with cervical cosmetic needs.
对于大多数甲状腺乳头状癌（PTC）患者和外科医生来说，内镜手术（ES）中远程访问方法的技术难度和创伤可能令人生畏。本研究的目的是介绍经锁骨下入路的无气单切口 ES（ESSA），并探讨其用于颈侧区清扫术（LND）的安全性和有效性。
2022 年 1 月至 2023 年 2 月，我们回顾性分析了 17 例接受 ESSA 行 LND 的 PTC 患者。此外，同期纳入了 22 例行视频辅助 ES（VAES）和 48 例行开放手术（OP）行 LND 的患者。比较 ESSA 与其他两组（VAES 和 OP）的淋巴结清扫量（LNY）、并发症和疗效。
ESSA 行中央和颈侧区清扫术的 LNY 与 VAES 相当（9.2±8.1 对 9.5±4.2，P=0.986；33.5±11.6 对 30.6±9.2，P=0.382），与 OP 也相当（9.2±8.1 对 11.0±5.4，P=0.420；33.5±11.6 对 31.5±7.9，P=0.383）。ESSA 术后 1 个月和 3 个月的吞咽障碍评分明显低于 VAES（1.8±1.0 对 3.0±1.2，P=0.003；0.9±0.8 对 1.7±0.8，P=0.006）。术后 1 个月 ESSA 组的美容满意度明显高于 VAES 组（100%对 31.8%，P<0.001）。
ESSA 是一种安全微创的手术方法，可提供无颈纹的颈部外观，对 LND 具有良好的疗效。因此，对于有颈部美容需求的 N1b 期 PTC 患者，ESSA 可能是一种可行的选择。
