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Thyroidectomy for thyroid cancer via transareola single-site endoscopic approach: results of a case-match study with large-scale population

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Abstract

Background

Due to technical challenges, single-site endoscopic thyroidectomy (SSET) is seldom reported and has been attempted in only limited cases. This large-scale study aimed to compare the clinical outcomes of standardized transareola SSET (TASSET) with those of conventional open thyroidectomy (COT) for thyroid cancer.

Methods

The data were prospectively collected, and case-match study was performed at a ratio of 1:1 according to age, sex, body mass index, lesion size, number of lesion foci, lesion side, recurrent laryngeal nerve (RLN) exploration and pathology. Two hundred eligible patients underwent TASSET, and the same number of patients was selected for propensity score matching from 2256 patients who underwent COT. Perioperative data, including surgical profile, oncological and traumatic burdens, and cosmetic satisfaction, were analyzed.

Results

No significant differences were observed in blood loss or drainage between TASSET and COT groups. There were no differences in operation time between TASSET and COT (106.39 ± 28.44 vs 102.55 ± 23.10 min, p = 0.154). A total of 3.63 ± 1.82 lymph nodes (LNs) were retrieved from CND with 0.96 ± 1.42 positive in TASSET. In COT, the total and positive LN yields were 3.77 ± 1.91 and 0.99 ± 1.40 (p = 0.445, p = 0.802). Cancer recurrence was not observed in either group. There were no differences in the occurrence of permanent and transient hoarseness or RLN injuries. Postoperative flap seroma or hematoma occurred in 12 TASSET patients and 58 COT patients (p < 0.001). The pain score, CRP level and ESR in TASSET group were lower than those in COT group. TASSET yielded significantly better incision recovery and cosmetic scores than did COT at both the proliferation and stabilization stages.

Conclusions

TASSET is technically feasible and yields enhanced recovery with minimally invasive and cosmetic advantages without compromising the level of safety or cancer eradication.

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Data availability

Data and materials will be shared.

Abbreviations

CND:

Central neck dissection

DTC:

Differentiated thyroid cancer

COT:

Conventional open thyroidectomy

ERAS:

Enhanced recovered after surgery

SSET:

Single-site endoscopic thyroidectomy

TASSET:

Transareola single-site endoscopic thyroidectomy

AJCC:

American Joint Committee on Cancer

LN:

Lymph node

BMI:

Body mass index

RLN:

Recurrent laryngeal nerve

FNA:

Fine needle aspiration

CNs:

Carbon nanoparticles

VAS:

Visual analog score

ESR:

Erythrocyte sedimentation rate

CRP:

C-reactive protein

PSS:

Patient Satisfaction Score

POSAS:

Patient and Observer Scar Assessment Scale

OSAS:

Observer scar assessment scale

PSAS:

Patient scar assessment scale

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Acknowledgements

This project was in line with the requirements of the Helsinki Declaration. The standard operative consent and research consent of the research was approved by Ethics Committee and the Institutional Review Board of Ruijin hospital affiliated to Shanghai Jiao Tong University school of Medicine (Ruijin LL-14-2006). This work is compliant with the STROCSS criteria (Strengthening the reporting of cohort studies in surgery), and has been registered at http://www.researchregistry.com (UIN:researchregistry5132).

Funding

This study was supported by Nature Science Foundation of China (NSFC, 81772558, 82072948); Medical Health Foundation of Chang Ning District, Shanghai (CNKW2017Y30).

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Author notes

  1. Juyong Liang, Ling Zhan and Ming Xuan are joint first authors.

Authors and Affiliations

  1. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Juyong Liang, Ling Zhan, Qiwu Zhao, Lingxie Chen, Jiqi Yan, Jie Kuang & Weihua Qiu

  2. Department of General Surgery, Ruijin Hospital Gubei Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China

    Ming Xuan & Jian Tan

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  1. Juyong Liang
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Contributions

JL, LZ wrote the manuscript and analyzed the data. QZ, LC analyzed the data. MX, JT, WQ designed the study and performed most of the surgery procedures. JK performed the surgery procedures and collected surgical images. JY performed the surgery procedures.

Corresponding authors

Correspondence to Jie Kuang, Jian Tan or Weihua Qiu.

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Disclosures

Juyong Liang, Ling Zhan, Ming Xuan, Qiwu Zhao, Lingxie Chen, Jiqi Yan, Jie Kuang, Jian Tan, Weihua Qiu have no conflicts of interest or financial ties to disclose.

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Liang, J., Zhan, L., Xuan, M. et al. Thyroidectomy for thyroid cancer via transareola single-site endoscopic approach: results of a case-match study with large-scale population. Surg Endosc 36, 1394–1406 (2022). https://doi.org/10.1007/s00464-021-08424-y

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