En bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in papillary thyroid carcinoma

Abstract

IntroductionThe current study presents a preliminary exploration of en bloc resection via a gasless transoral approach in papillary thyroid carcinoma.ObjectiveThis study aimed to summarize and explore the efficacy and safety of en bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in patients with papillary thyroid carcinoma.MethodsThis study was conducted between January 2021 and December 2021. It involved 30 patients with bilateral papillary thyroid carcinoma who had undergone en bloc resection of the total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach using a three-trocar and four-instrument technique at The First Affiliated Hospital of the University of Science and Technology of China. The key steps and difficulties of the operation were summarized, and the clinicopathological characteristics and surgical complications of patients were analyzed.ResultsAll operations were successful without conversion to open surgery. The pathological diagnosis was bilateral papillary thyroid carcinoma. The mean maximum tumor diameter was 0.85 ± 0.51 cm (range 0.3–2.5 cm). There was no case of gross capsular invasion. The mean number of harvested central compartment lymph nodes was 11.36 ± 5.36. Central compartment lymph node metastases were found in 16 patients (53.3%) with a mean of 1.53 ± 2.39. On the other hand, lymphocytic thyroiditis was observed in 12 cases (40%), and microscopic capsular invasion was observed in five cases (16.6%). All patients had normal parathyroid hormone levels after the operation. However, one patient developed hoarseness after the operation due to injury of the recurrent laryngeal nerve branch, but there was no numbness of the mandible and lower lip or infection of the oral incision.ConclusionThe study revealed that the three-trocar and four-instrument technique can be used in the en bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach without disconnecting the thyroid isthmus. As a result, the operation is considered effective and safe. Therefore, this technique may be a better surgical method for patients with bilateral thyroid cancer and cosmetic needs.

Feasibility and safety of modified en-bloc resection in endoscopic thyroid surgery via bilateral areolar approach – long-term institutional analysis ten years after surgery

“…En-bloc resection is an appropriate approach aligned with the oncologic concept ( 8 ) and has been practiced in thyroid surgery at our institution since January 2010 ( 25 ). Our current study revealed a notable increase in the number of lymph nodes obtained in the modified en-bloc group (7.5 ± 4.5) compared to the conventional group (5.6 ± 3.6) (P < 0.01).…”

“…(7) Complete the en-bloc resection of the thyroid and central compartment and save the superior parathyroid gland by cutting close by the thyroid capsule. (8) Resect the posterior lymph nodes around the recurrent laryngeal nerve when necessary (Supplementary Video 1).…”

“…En-bloc resection, originally introduced for radical mastectomy in 1952, provides an alternative technique for resecting solid tumors and lymph-node chains, including those related to head and neck tumors, and thyroid cancers (7)(8)(9). However, the safety and feasibility of performing en-bloc resection during thyroidectomy and lymph node dissection are not yet well-established, particularly with the endoscopic method, as there is a lack of long-term followup studies (10).…”