Chen Zhen-Xin, Zhao Xin-Ran, Pang Feng-Shun, Chen Jing-Bao, Song Ya-Min, Cao Ying, Lin Zhan-Hong, Xu Bo, Qin You
Department of Minimally Invasive Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of TCM), Guangzhou, 510120, People's Republic of China.
Department of General Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, People's Republic of China.
Surg Endosc. 2025 Jan;39(1):204-211. doi: 10.1007/s00464-024-11376-8. Epub 2024 Nov 4.
The combined trans-oral and chest approach is a novel technique for endoscopic selective neck dissection (SND), with satisfactory oncological safety and cosmetic results. However, this hybrid approach is difficult, and the learning curve remains unclear. In this study, we aimed to evaluate the short-term outcomes for this hybrid approach, and to define the associated learning curve.
Clinical data and surgical outcomes of 58 PTC patients who underwent endoscopic SND via combined trans-oral and chest approach between September 2020 and April 2023 were retrospectively reviewed. The cumulative sum (CUSUM) sequential analysis technique is used to detect change, and has been applied for the evaluation of learning curves.
The study population included 58 patients (40 females, 18 males), with mean age of 38.9 ± 12.7 years and average body mass index of 22.6 ± 4.8 kg/m. In all cases, the same surgical team performed endoscopic SND via combined trans-oral and chest approach. The numbers of positive/retrieved lymph nodes were 4.3 ± 3.2/27.8 ± 8.4 in the lateral compartment and 4.0 ± 3.5/8.4 ± 5.1 in the central compartment. The learning curve was evaluated in terms of an initial phase (20 cases) and a mature phase (38 cases). Operative time was longer during the initial phase, compared to the mature phase (375.2 vs. 274.6 min, p = 0.002). The frequency of operative complications was higher during the initial phase, compared to the mature phase (85% vs. 55.3%, p = 0.048).
After the experience acquired using endoscopic SND via combined trans-oral and chest approach to treat PTC in 20 patients, the number of complications decreased significantly. Compared to data collected for the initial phase, data collected for the mature phase showed trends toward decreased operating time.
经口联合胸部入路是一种用于内镜下选择性颈清扫术（SND）的新技术，具有令人满意的肿瘤学安全性和美容效果。然而，这种联合入路操作难度大，学习曲线仍不明确。在本研究中，我们旨在评估这种联合入路的短期效果，并确定相关的学习曲线。
回顾性分析2020年9月至2023年4月期间58例行经口联合胸部入路内镜下SND的PTC患者的临床资料和手术结果。采用累积和（CUSUM）序贯分析技术检测变化，并已应用于学习曲线的评估。
研究人群包括58例患者（40例女性，18例男性），平均年龄38.9±12.7岁，平均体重指数22.6±4.8kg/m²。所有病例均由同一手术团队行经口联合胸部入路内镜下SND。外侧区阳性/取出淋巴结数为4.3±3.2/27.8±8.4，中央区为4.0±3.5/8.4±5.1。学习曲线根据初始阶段（20例）和成熟阶段（38例）进行评估。与成熟阶段相比，初始阶段手术时间更长（375.2分钟对274.6分钟，p = 0.002）。与成熟阶段相比，初始阶段手术并发症发生率更高（85%对55.3%，p = 0.048）。
在有了使用经口联合胸部入路内镜下SND治疗20例PTC患者的经验后，并发症数量显著减少。与初始阶段收集的数据相比，成熟阶段收集的数据显示手术时间有缩短趋势。
