Oh Moon Young, Oh So Won, Kim Young A, Chai Young Jun
Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.
Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.
Gland Surg. 2024 Feb 29;13(2):265-273. doi: 10.21037/gs-23-480. Epub 2024 Feb 23.
While track recurrence of thyroid cancer following endoscopic and robotic transaxillary surgeries has been reported previously, no such cases have been reported for transoral endoscopic thyroidectomy vestibular approach (TOETVA). This case report describes the first documented case of recurrence of thyroid cancer along the surgical track after TOETVA.
The patient underwent right lobectomy via TOETVA for a 4 cm follicular thyroid carcinoma (FTC) initially diagnosed as benign follicular nodule on preoperative gun biopsy. The thyroid capsule partially ruptured within the surgical field during surgery. Ultrasonography and computed tomography conducted 27 months after surgery revealed seeding recurrence in the postsurgical thyroid bed, and subcutaneous layers of the right lower lip, submental area, and mid to right upper neck levels I, IIA, and VI. Two-stage re-operation was done to perform completion thyroidectomy, lymph node dissection, and excision of recurrent nodules, which were pathologically confirmed as metastatic FTC. The patient underwent two treatments of radioactive iodine therapy, and post-therapeutic whole-body scintigraphy and computed tomography showed no residual disease.
Careful monitoring after TOETVA is essential due to the rare but potential risk of seeding recurrence, especially when the thyroid gland ruptures during surgery. Surgeons should be aware of this atypical complication and be prepared to recommend surgical and/or medical strategies to manage any local seeding of thyroid tissue that may occur.
虽然先前已有内镜和机器人经腋窝手术治疗甲状腺癌后出现手术通道复发的报道，但经口内镜甲状腺手术前庭入路（TOETVA）尚未见此类病例报道。本病例报告描述了首例有记录的TOETVA术后手术通道甲状腺癌复发的病例。
患者因术前细针穿刺活检最初诊断为良性滤泡性结节的4cm滤泡状甲状腺癌（FTC），接受了经TOETVA的右叶切除术。手术过程中甲状腺包膜在手术野内部分破裂。术后27个月进行的超声和计算机断层扫描显示，手术甲状腺床、右下唇皮下层、颏下区域以及右颈中上部I、IIA和VI区出现种植性复发。进行了两阶段再次手术，完成甲状腺切除术、淋巴结清扫和复发病灶切除，病理证实为转移性FTC。患者接受了两次放射性碘治疗，治疗后全身闪烁扫描和计算机断层扫描显示无残留病灶。
由于存在罕见但潜在的种植性复发风险，尤其是手术中甲状腺腺体破裂时会发生，因此TOETVA术后仔细监测至关重要。外科医生应意识到这种非典型并发症，并准备好推荐手术和/或医疗策略来处理可能发生的任何甲状腺组织局部种植。
