Scarless endoscopic thyroidectomy (SET) lateral neck dissection for papillary thyroid carcinoma through breast approach: 10 years of experience

Abstract

Background Breast approach endoscopic thyroidectomy with lateral neck lymph node metastases dissection has been described. However, in this article, we report on 10 years' experience with the breast approach to patients with endoscopic thyroidectomy with level II, III, and IV lateral neck dissection (LND). Patients with papillary thyroid carcinoma (PTC) who received scarless endoscopic thyroidectomy (SET) were included to evaluate its therapeutic effect. Methods Between June 2009 and June 2019, we selected 155 patients with PTC with level II, III, or IV level lymph node metastasis suspected. Ipsilateral level II, III, and IV dissection was performed, accompanied by thyroidectomy and central compartment dissection. In addition, 102 patients received conventional open LND during the same period and were included. Clinicopathological characteristics, outcomes, and tumor prognosis were retrospectively compared in the two groups. Results During the 10 years, the submitted patients' clinicopathological characteristics including tumor size, tumor stage, retrieved lymph nodes number, complication rates, postoperative PTH, and mean postoperative hospital stay were similar between the SET and open group. The mean operating time in the SET group (278.2 ± 38.6 min) was longer than in the open group (179.3 ± 25.4 min). The recurrent rate was not significantly different (2/155, 2/106) in the SET and conventional open group. Conclusion The safety and oncological completeness dissection of SET was similar to that of open procedures. SET is an effective treatment approach for patients with PTC having cosmetic results' demand of lateral neck lymph node metastases. Keywords Scarless endoscopic thyroidectomy • Lateral neck dissection • Thyroid cancer Abbreviations PTC Papillary thyroid carcinoma BAET Breast approach Endoscopic thyroidectomy LND Lateral neck dissection Since Gagner first reported endoscopic parathyroidectomy in 1996 [1], endoscopic thyroidectomy has developed rapidly. Endoscopic thyroid surgery now has been applied to patients with thyroid cancer and achieved excellent cosmetic results accompanied by effective lesions oncologically resected [2]. Various approaches including the transoral [3] approach, axillary approach [4], and robotic thyroidectomy [5] were appeared to conduct the endoscopy thyroid surgery process. Lateral neck dissection (LND) with a conventional open incision is the standard approach, and the consequence is a long scar on the neck that inevitably yields poor cosmetic results. To avoid the anterior neck scar in patients with PTC, endoscopy and video-assisted approaches were implemented to improve the cosmetic result [6, 7]. However, the scarless endoscopic thyroidectomy (SET) for LND remains controversial, and there are technical difficulties. Our surgical team reported our initial several cases of experience related to SET for LND [8]. In another report, few received cases were included, and the advantages and problems of this method have not been fully demonstrated [9]. Over 10 years, we performe...

Salvage surgery for cervical radioiodine refractory 18F-FDG-PET positive recurrence of papillary thyroid cancer

“…Differentiated thyroid cancer (DTC) is often diagnosed postoperatively after resection of sonographic and/or cytological suspicious thyroid nodules. Since its prognosis is excellent in most cases, the main goals of surgery are, alongside with complete tumor resection, low morbidity, and satisfying cosmetic results ( 1 ). The use of prophylactic resection of clinically not involved central lymph nodes for papillary thyroid cancer (PTC), for example, is very controversial ( 2 , 3 , 4 ); it bears the risk of postoperative hypocalcemia, and radioiodine treatment (RAI) is known to treat micrometastatic disease ( 5 ).…”

“…Differentiated thyroid cancer (DTC) is often diagnosed postoperatively after resection of sonographic and/or cytological suspicious thyroid nodules. Since its prognosis is excellent in most cases, main goals of surgery are, alongside with complete tumor resection, low morbidity and satisfying cosmetic results [1].…”

Qin’s seven steps for endoscopic selective lateral neck dissection via the chest approach in patients with papillary thyroid cancer: experience of 35 cases

“…We had performed over 1200 ESTC procedures at our center before performing endoscopic selective LND. However, the mean operative time was 307.5 ± 74.4 min, which is much longer than that of open surgery [2,15]. In summary, Qin's seven steps for endoscopic selective LND via the chest approach in patients with differentiated thyroid cancer is a safe approach and achieves good cosmetic results.…”

“…Lateral neck dissection (LND) is recommended for these patients to improve the prognosis [10,11]. However, the traditional open LND necessitates a large neck incision, which has a detrimental effect on the quality of life of patients [2,[12][13][14]. A few studies have reported complete endoscopic dissection of the lateral lymph nodes [2,14,15]; however, it is a technically challenging procedure that requires surgical expertise.…”

Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery

“…The working space is filled with CO 2 , maintaining a pressure of approximately 7 mmHg. Devices have been introduced in this kind of approach, such as U-shaped retractors, suspension sutures, ultrasonic coagulators, and minilap (31,(37)(38)(39)(40)(41)(42)(43).…”