Long Tengjiang, Li Junlei, Yuan Yuquan, Yang Zeyu, Xu Peng, Pan Bin, Sun Yiceng, Yin Supeng, Zhao Chengzhi, Zhang Fan
Graduate School of Medicine, Chongqing Medical University, Chongqing, China.
Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China.
Gland Surg. 2025 Jan 24;14(1):1-12. doi: 10.21037/gs-24-424. Epub 2025 Jan 20.
Different approaches to endoscopic total thyroidectomy are emerging for the treatment of differentiated thyroid cancer, raising clinical concerns about comprehensively evaluating the strengths and weaknesses of these approaches. In this study, we aimed to conduct a network meta-analysis to compare different endoscopic surgical approaches to total thyroidectomy, revealing their respective advantages and limitations.
PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2024. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to determine the probability that each surgical approach for the best individual outcome.
Twenty-one studies comprising 4,361 patients were included. Based on the SUCRA value, the endoscopic transoral approach (EOA) retrieved the highest number of lymph nodes (LNs) (SUCRA =0.59) among all endoscopic surgical approaches. The minimally invasive video-assisted approach (MIVAA) significantly shortened the operative time (SUCRA =0.77) compared to other endoscopic surgical approaches. MIVAA ranked as the most effective surgical approach for reducing the rate of permanent hypoparathyroidism (SUCRA =0.81) and controlling intraoperative bleeding (SUCRA =0.77). The endoscopic gasless transaxillary approach (EGAA) effectively shortened the hospital stay (SUCRA =0.95) and reduced the rate of transient hypoparathyroidism (SUCRA =0.74). The endoscopic bilateral areola (EBAA) approach ranked as the most effective surgical approach for preventing recurrent laryngeal nerve (RLN) palsy (SUCRA =0.92).
The surgical outcomes of endoscopic total thyroidectomy are comparable to those of open thyroidectomy. MIVAA was superior to other endoscopic surgical approaches in terms of operative time, intraoperative bleeding volume, and permanent hypoparathyroidism rate. EOA demonstrated a significant advantage in LNs retrieval. EBAA was superior in protecting the RLN.
针对分化型甲状腺癌的治疗，内镜全甲状腺切除术的不同术式不断涌现，这引发了对全面评估这些术式优缺点的临床关注。在本研究中，我们旨在进行一项网状Meta分析，以比较全甲状腺切除术的不同内镜手术方式，揭示它们各自的优势和局限性。
检索PubMed、Medline、Cochrane图书馆、Web of Science和EMBASE数据库，检索时间从建库至2024年3月。进行成对Meta分析和贝叶斯网状Meta分析。累积排序曲线下面积（SUCRA）用于确定每种手术方式获得最佳个体结局的概率。
纳入21项研究，共4361例患者。基于SUCRA值，在内镜手术方式中，经口内镜入路（EOA）清扫的淋巴结数量最多（SUCRA =0.59）。与其他内镜手术方式相比，微创视频辅助入路（MIVAA）显著缩短了手术时间（SUCRA =0.77）。MIVAA在降低永久性甲状旁腺功能减退发生率（SUCRA =0.81）和控制术中出血方面（SUCRA =0.77）是最有效的手术方式。内镜无气腋窝入路（EGAA）有效缩短了住院时间（SUCRA =0.95）并降低了暂时性甲状旁腺功能减退发生率（SUCRA =0.74）。内镜双侧乳晕入路（EBAA）在预防喉返神经（RLN）麻痹方面是最有效的手术方式（SUCRA =0.92）。
内镜全甲状腺切除术的手术效果与开放性甲状腺切除术相当。MIVAA在手术时间、术中出血量和永久性甲状旁腺功能减退发生率方面优于其他内镜手术方式。EOA在淋巴结清扫方面具有显著优势。EBAA在保护喉返神经方面更具优势。
