Skip to main content

Advertisement

SpringerLink
Log in

Oncologic safety and surgical outcomes of the different surgical approaches of endoscopic thyroidectomy for papillary thyroid carcinoma

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the oncologic safety and surgical outcomes of endoscopic thyroidectomy (ET) performed via different surgical approaches for papillary thyroid carcinoma (PTC).

Methods

We reviewed the medical records of PTC patients who underwent ET between May 2015 and May 2021, at the Department of General Surgery, Beijing Friendship Hospital (affiliated with Capital Medical University). The patients were divided into three groups: the ET via breast approach (ETBA) group, the transoral ET vestibular approach (TOETVA) group, and the ET via transaxillary approach (ETTA) group. We evaluated the safety and surgical outcomes of each of these ET approaches.

Results

A total of 490 patients were included in the analysis: 416 in the ETBA group, 57 in the TOETVA group, and 17 in the ETTA group. There were no significant differences among the groups in clinicopathologic characteristics or surgical procedures, or in the incidences of complications such as hematoma, subcutaneous emphysema, infection, and chyle. The incidences of transient and permanent recurrent laryngeal nerve (RLN) injury were 1.4% and 4.3%, respectively, with no significant difference among the three groups. The incidences of transient and permanent postoperative hypoparathyroidism were 13.7% and 1.4%, respectively. The incidence of transient hypoparathyroidism in the TOETVA group was 1.7%, which was significantly lower than that in the ETBA group. The postoperative 1-, 3- and 5-year rates of disease-free survival were 99.5%, 96.8%, and 95.9%, respectively. Univariate and multivariate analyses showed that ET was not a significant risk factor for recurrence or metastasis (p = 0.83 and p = 0.49, respectively), regardless of the surgical approach.

Conclusions

TOETVA may be associated with a lower incidence of temporary hypoparathyroidism than ETBA. Apart from this difference, ETBA, ETTA and TOETVA showed comparable oncologic safety and surgical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg. 1996;83:875.

    Article  CAS  PubMed  Google Scholar 

  2. Hüscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc. 1997;11:877.

    Article  PubMed  Google Scholar 

  3. Yang Y, Gu XD, Wang XX, Xiang JB, Chen ZY. Endoscopic thyroidectomy for differentiated thyroid cancer. ScientificWorldJournal. 2012;2012: 456807. https://doi.org/10.1100/2012/456807.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lira RB, De Cicco R, Rangel LG, Bertelli AA, Duque Silva G, de Medeiros Vanderlei JP, et al. Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients. Head Neck. 2021;43:3468–75.

    Article  PubMed  Google Scholar 

  5. Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg. 2016;40:491–7.

    Article  PubMed  Google Scholar 

  6. Dionigi G, Chai YJ, Tufano RP, Anuwong A, Kim HY. Transoral endoscopic thyroidectomy via a vestibular approach: why and how? Endocrine. 2018;59:275–9.

    Article  CAS  PubMed  Google Scholar 

  7. Qu YQ, Han YB, Wang WJ, Zhang XJ, Ma JH. Clinical analysis of total endoscopic thyroidectomy via breast areola approach in early differentiated thyroid cancer. J BUON. 2021;26:1022–7.

    PubMed  Google Scholar 

  8. Wang B, Zhu CR, Liu H, Yao XM, Wu J. The ability of near-infrared autofluorescence to protect parathyroid gland function during thyroid surgery: a meta-analysis. Front Endocrinol (Lausanne). 2021;12: 714691.

    Article  PubMed  Google Scholar 

  9. Cao W, Chen HD, Yu YW, Li N, Chen WQ. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl). 2021;134:783–91.

    Article  PubMed  Google Scholar 

  10. Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G. Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg. 2008;32:381–5.

    Article  PubMed  Google Scholar 

  11. Hong HJ, Kim WS, Koh YW, Lee SY, Shin YS, Koo YC, et al. Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas: preliminary results. Yonsei Med J. 2011;52:643–54.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Liu ZD, Li YJ, Wang Y, Xiang C, Yu X, Zhang ML, et al. Comparison of the transoral endoscopic thyroidectomy vestibular approach and open thyroidectomy: a propensity score-matched analysis of surgical outcomes and safety in the treatment of papillary thyroid carcinoma. Surgery. 2021;170:1680–6.

    Article  PubMed  Google Scholar 

  13. Wongwattana P, Laoveerakul P, Santeerapharp A. A comparison of efficacy and quality of life between transoral endoscopic thyroidectomy vestibular approach (TOETVA) and endoscopic thyroidectomy axillo-breast approach (ETABA) in thyroid surgery: non-randomized clinical trial. Eur Arch Otorhinolaryngol. 2021;278:4043–9.

    Article  PubMed  Google Scholar 

  14. Bakkar S, Al Hyari M, Naghawi M, Corsini C, Miccoli P. Transoral thyroidectomy: a viable surgical option with unprecedented complications-a case series. J Endocrinol Invest. 2018;41:809–13.

    Article  CAS  PubMed  Google Scholar 

  15. Akritidou E, Douridas G, Spartalis E, Tsourouflis G, Dimitroulis D, Nikiteas NI. Complications of trans-oral endoscopic thyroidectomy vestibular approach: a systematic review. In Vivo. 2022;36:1–12.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Maeda S, Uga T, Hayashida N. Video-assisted subtotal or near-total thyroidectomy for Graves’ disease. Br J Surg. 2006;93:61–6.

    Article  CAS  PubMed  Google Scholar 

  17. Angkoon A, Khwannara K, Pornpeera J, Sasanakietkul T, Duh QY. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg. 2018;153:21–7.

    Article  Google Scholar 

  18. Zhang DQ, Sun H, Tufano R, Caruso E, Dionigi G, Kim HY. Recurrent laryngeal nerve management in transoral endoscopic thyroidectomy. Oral Oncol. 2020;108: 104755.

    Article  PubMed  Google Scholar 

  19. Li YJ, Zhou XD. Comparison between endoscopic thyroidectomy and conventional open thyroidectomy for papillary thyroid microcarcinoma: a meta-analysis. J Cancer Res Ther. 2016;12:550–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research, National Clinical Research Center for Digestive Diseases, Beijing, People’s Republic of China

    Wei Xu, Changsheng Teng, Guoqian Ding & Ning Zhao

Authors
  1. Wei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Changsheng Teng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guoqian Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ning Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ning Zhao.

Ethics declarations

Conflict of interest

Wei Xu, Changsheng Teng, Guoqian Ding and Ning Zhao have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, W., Teng, C., Ding, G. et al. Oncologic safety and surgical outcomes of the different surgical approaches of endoscopic thyroidectomy for papillary thyroid carcinoma. Surg Today 53, 554–561 (2023). https://doi.org/10.1007/s00595-022-02630-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02630-4

Keywords

Search

Navigation