Guerlain Joanne, Breuskin Ingrid, Abbaci Muriel, Lamartina Livia, Hadoux Julien, Baudin Eric, Al Ghuzlan Abir, Moog Sophie, Marhic Alix, Villard Adrien, Obongo Rais, Hartl Dana M
Department of Head and Neck Cancer and ENT Surgery, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
Plate-Forme Imagerie et Cytométrie, UMS 23/3655, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
Cancers (Basel). 2023 Dec 29;16(1):182. doi: 10.3390/cancers16010182.
Hypoparathyroidism is the most frequent complication in thyroid surgery. The aim of this study was to evaluate the impact of intraoperative parathyroid gland identification, using autofluorescence imaging, on the rate of post-operative (PO) hypoparathyroidism in thyroid cancer surgery. Patients undergoing total thyroidectomy with central neck dissection from 2018 to 2022 were included. A prospective cohort of 77 patients operated on using near-infrared autofluorescence (NIRAF+) with the Fluobeam (Fluoptics, Grenoble, France) system was compared to a retrospective cohort of 94 patients (NIR-). The main outcomes were the rate of PO hypocalcemia, with three cutoffs: corrected calcium (Cac) < 2.10 mmol/L, <2.00 mmol/L and <1.875 mmol/L, and the rate of permanent hypoparathyroidism, at 12 months. The rate of PO Cac < 2.10 mmol/L was statistically lower in the NIRAF+ group, compared to the control group (36% and 60%, = 0.003, respectively). No statistically significant difference was observed for the other two thresholds. There was a lower rate of permanent hypoparathyroidism in the NIRAF+ group (5% vs. 14% in the control group), although not statistically significant ( = 0.07). NIRAF is a surgically non-invasive adjunct, and can improve patients' outcomes for thyroid cancer surgery by reducing post-operative temporary hypoparathyroidism. Larger prospective studies are warranted to validate our findings.
甲状旁腺功能减退是甲状腺手术中最常见的并发症。本研究的目的是评估术中使用自体荧光成像识别甲状旁腺对甲状腺癌手术术后甲状旁腺功能减退发生率的影响。纳入了2018年至2022年接受全甲状腺切除术并进行中央区淋巴结清扫的患者。将使用法国格勒诺布尔Fluoptics公司的Fluobeam系统进行近红外自体荧光成像（NIRAF+）手术的77例患者的前瞻性队列与94例患者的回顾性队列（NIR-）进行比较。主要结局指标为术后低钙血症发生率，设定三个临界值：校正钙（Cac）<2.10 mmol/L、<2.00 mmol/L和<1.875 mmol/L，以及12个月时永久性甲状旁腺功能减退的发生率。与对照组相比，NIRAF+组术后Cac< 2.10 mmol/L的发生率在统计学上较低（分别为36%和60%，P = 0.003）。对于其他两个临界值，未观察到统计学上的显著差异。NIRAF+组永久性甲状旁腺功能减退的发生率较低（5% vs. 对照组的14%），尽管无统计学意义（P = 0.07）。NIRAF是一种手术非侵入性辅助手段，可通过减少术后暂时性甲状旁腺功能减退来改善甲状腺癌手术患者的预后。需要开展更大规模的前瞻性研究来验证我们的研究结果。
