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Li X, Ding W, Zhang H. Surgical outcomes of endoscopic thyroidectomy approaches for thyroid cancer: a systematic review and network meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1256209. [PMID: 38111707 PMCID: PMC10726028 DOI: 10.3389/fendo.2023.1256209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 12/20/2023] Open
Abstract
Objectives This network meta-analysis assesses the outcomes of seven endoscopic approaches, offering valuable insights for researchers and practitioners in choosing the best method for thyroid cancer patients. Methods A systematic literature search was conducted in the PubMed, Embase and Web of Science databases up to March 2023. The analysis included seven endoscopic approaches, with a focus on their respective outcomes through network meta-analysis. Results This meta-analysis included 44 studies involving 8,672 patients. The axillo-bilateral breast approach (ABBA) and unilateral axillo-breast approach (UABA) showed advantages in terms of reduced operative time compared to other approaches (MD = 19.66 minutes, 95% CI = -31.66 to 70.98; MD = 30.32 minutes, 95% CI = -1.45 to 62.09, respectively). The UABA and anterior chest approach (ACA) exhibited superiority in controlling intraoperative bleeding (MD = -3.37 mL, 95% CI = -22.58 to 15.85; MD = -13.77 mL, 95% CI = -28.85 1.31, respectively). UABA and ACA also showed advantages in reducing hospital stays (MD = -0.39 days, 95% CI = -1.48 to 0.71; MD = -0.26 days, 95% CI = -1.33 to 0.81, respectively). The transoral approach (OA) yielded results comparable to those of conventional open thyroidectomy (COT) and outperformed other endoscopic surgeries with regards to lymph node retrieval and metastatic lymph node assessment. For the stimulated serum thyroglobulin (TG) levels, no significant difference was observed between bilateral axillo-breast approach (BABA) and OA compared to COT. However, chest-breast approach (CBA) showed significantly lower levels than COT (MD=-0.40 ng/ml, 95% CI =-0.72 to -0.09). Patients in the gasless unilateral transaxillary approach (GUA) group experienced a significant improvement in cosmetic satisfaction (MD=-2.08, 95% CI =-3.35 to -0.82). Importantly, no significant difference was observed in the incidence of surgical complications between endoscopic thyroidectomy and COT. Conclusion Endoscopic thyroid surgery is a safe and effective choice for thyroid cancer patients. Different approaches have their advantages, allowing personalized selection based on the patient's needs. ABBA and UABA have shorter operative times, while UABA and ACA excel at controlling bleeding and shortening hospital stays. OA shows promise for lymph node assessment. These findings contribute to the growing evidence supporting endoscopic methods, expanding treatment options for thyroid cancer patients.
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Affiliation(s)
| | | | - Hong Zhang
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
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Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, Tian HW, Feng SW, Han CW, Yang J, Yang KH, Guo TK. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc 2020; 34:1891-1903. [PMID: 32144555 DOI: 10.1007/s00464-019-07283-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC). METHOD Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis. RESULTS The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05). CONCLUSIONS The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.
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Affiliation(s)
- Wen-Jie Jiang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, People's Republic of China
| | - Pei-Jing Yan
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Chun-Lin Zhao
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, People's Republic of China
| | - Mou-Bo Si
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Wen Tian
- Department of General Surgery, First Clinical Center, PLA General Hospital, Beijing, 100000, People's Republic of China
| | - Yan-Jun Zhang
- Department of General Surgery, First Clinical Center, PLA General Hospital, Beijing, 100000, People's Republic of China
| | - Hong-Wei Tian
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Shuang-Wu Feng
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Cai-Wen Han
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Jia Yang
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China
| | - Ke-Hu Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, People's Republic of China.
| | - Tian-Kang Guo
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China.
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