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Endoscopic thyroidectomy via the combined trans-oral and chest approach for cT1-2N1bM0 papillary thyroid carcinoma

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Abstract

Background

Recent years there have been witnessed considerable advances in endoscopic selective lateral neck dissection (LND). However, dissection of lymph nodes at level IV and level VI via the chest approach is inherently challenging. In this study, we used combined trans-oral and chest approach for endoscopic thyroidectomy in patients with cT1-2N1bM0 papillary thyroid carcinoma (PTC).

Methods

Clinical characteristics and surgical outcomes of ten patients with cT1-2N1bM0 PTC who underwent endoscopic thyroidectomy via combination of trans-oral and chest approach between September 2020 and September 2021 were retrospectively reviewed.

Results

All 10 patients successfully underwent total thyroidectomy and selective LND via chest approach, while central neck dissection (CND) and supplementary dissection of lymph nodes at level IV were performed via the trans-oral approach. The mean number of positive/retrieved level II, III-IV, and VI lymph nodes were 0.6 ± 1.0/9.8 ± 5.0, 4.6 ± 2.8/23.1 ± 4.7, and 4.9 ± 3.4/10.3 ± 4.6, respectively. Four patients developed transient hypoparathyroidism which spontaneously resolved within 1 month. Five patients developed numbness of lateral neck and ear and one patient experienced limb lift restriction. No other complications or tumor recurrence occurred during follow-up.

Conclusion

It is feasible to perform total thyroidectomy, CND, and selective LND via combined trans-oral and chest approach, and satisfactory short-term outcomes were observed in this cohort. This approach may offer one more option for cT1-2N1bM0 PTC patients, especially those in whom metastatic lymph nodes at level IV or level VI are detected by preoperative examination.

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Acknowledgements

The authors thank Medjaden Bioscience Limited for linguistic revision of the manuscript.

Funding

No funding was received.

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Author notes

  1. Zhen-Xin Chen, Ying Cao, and Li-Ming Yang have contributed equally to this work.

Authors and Affiliations

  1. 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

    Zhen-Xin Chen, Ying Cao, Li-Ming Yang, Jing-Bao Chen, Feng-Shun Pang, Zhan-Hong Lin, Xiao-Bo Zhang, Bei-Yuan Cai, Wei-Wu Zheng & You Qin

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  1. Zhen-Xin Chen
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Correspondence to You Qin.

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Zhen-Xin Chen, Ying Cao, Li-Ming Yang, Jing-Bao Chen, Feng-Shun Pang, Zhan-Hong Lin, Xiao-Bo Zhang, Bei-Yuan Cai, Wei-Wu Zheng, and You Qin have no conflicts of interest or financial ties to disclose.

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Chen, ZX., Cao, Y., Yang, LM. et al. Endoscopic thyroidectomy via the combined trans-oral and chest approach for cT1-2N1bM0 papillary thyroid carcinoma. Surg Endosc 36, 9092–9098 (2022). https://doi.org/10.1007/s00464-022-09376-7

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