Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 813414, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong Street, Taipei, 112304, Taiwan.
Updates Surg. 2024 Nov;76(7):2565-2571. doi: 10.1007/s13304-024-01922-3. Epub 2024 Jul 30.
Transoral endoscopic thyroidectomy is widely utilized for treating benign conditions and low-risk thyroid cancers, yet its use for completion thyroidectomy, especially when performed more than 2 weeks after an initial lobectomy, is less understood. In this retrospective study, we assessed patients who underwent endoscopic completion thyroidectomy via the transoral route, examining operative data and complications from both the initial lobectomy and the subsequent completion thyroidectomy, along with the pathological and oncologic outcomes of the latter surgery. Among the ten patients diagnosed with papillary carcinoma following an initial lobectomy who underwent a completion thyroidectomy via the same transoral approach, the median interval between surgeries was 5.4 months, with 80% of cases exceeding 3 months. All procedures were completed endoscopically without necessitating an open conversion. In 40% of these patients, additional microcarcinomas were identified in the contralateral thyroid lobe. Although the median operative time for completion thyroidectomy was longer (249 min) compared to the initial lobectomy (220 min), and postoperative pain scores on days 1 and 2 were slightly higher, and these differences were not statistically significant. Blood loss, drainage amounts, and hospital stay lengths were similar between both surgeries. The only major complication was transient hypoparathyroidism, occurring in 20% of the completion group, with 80% of patients achieving suppressed thyroglobulin levels of < 0.2 ng/mL postoperatively. Our findings demonstrate the practicality of using the transoral endoscopic vestibular approach for completion thyroidectomy, even when conducted more than 3 months after the initial lobectomy.
经口内镜甲状腺切除术广泛应用于治疗良性疾病和低危甲状腺癌，但对于完成甲状腺切除术，尤其是在初次甲状腺叶切除术后 2 周以上进行时，其应用较少被了解。在这项回顾性研究中，我们评估了通过经口途径行内镜下甲状腺完成切除术的患者，检查了初次甲状腺叶切除术中和随后的完成甲状腺切除术中的手术数据和并发症，以及后者手术的病理和肿瘤学结果。在因初次甲状腺叶切除术后诊断为甲状腺乳头状癌而接受经口相同途径完成甲状腺切除术的 10 例患者中，两次手术的中位间隔时间为 5.4 个月，80%的病例超过 3 个月。所有手术均在内镜下完成，无需转为开放性手术。在这些患者中的 40%，在对侧甲状腺叶中发现了额外的微癌。虽然完成甲状腺切除术的中位手术时间（249 分钟）比初次甲状腺叶切除术（220 分钟）长，并且术后第 1 天和第 2 天的疼痛评分略高，但这些差异无统计学意义。两次手术的出血量、引流量和住院时间相似。唯一的主要并发症是短暂性甲状旁腺功能减退，发生在完成组的 20%，80%的患者术后甲状腺球蛋白水平抑制到<0.2ng/ml。我们的研究结果表明，即使在初次甲状腺叶切除术后 3 个月以上，使用经口内镜前庭入路进行完成甲状腺切除术也是可行的。
