Total endoscopic thyroidectomy versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis

Abstract

BackgroundDespite the considerable experience gained thus far using endoscopic technologies, the role of total endoscopic thyroidectomy (ET) for papillary thyroid cancer (PTC) remains controversial. We conducted a systematic review and meta-analysis to investigate the safety and effectiveness of total ET compared with conventional open thyroidectomy (OT) in PTC.MethodsA systematic search was conducted using the PubMed, Embase and Cochrane Library electronic databases up to March 2018. The quality of included studies was evaluated using the Newcastle–Ottawa Scale. Review Manager software version 5.3 was used for the meta-analysis.ResultsTwelve studies including 2,672 patients were ultimately included in the systematic review and meta-analysis. ET was associated with longer operative time (P<0.00001), drainage time (P<0.00001) and hospital stay (P=0.03), higher transient recurrent laryngeal nerve (RLN) palsy rate (P=0.004) and a greater amount of drainage fluid (P<0.0001) compared with OT. Furthermore, no significant differences were detected between ET and OT in terms of retrieved lymph nodes (P=0.17), blood loss (P=0.22), transient hypocalcemia (P=0.84), permanent hypocalcemia (P=0.58), permanent RLN palsy (P=0.14), hematoma or bleeding (P=0.15) and seroma (P=0.54). In addition, the rates of tumor recurrence were comparable (P=0.18), whereas the proportions of stimulated thyroglobulin levels <1 ng/mL measured after completion of thyroidectomy and radioactive iodine therapy were less (P=0.02) in the ET than in the OT group.ConclusionET is not superior to OT in terms of operation and drainage time, amount of drainage fluid, hospital stay or transient RLN palsy, but is comparable to OT in terms of retrieved lymph nodes and permanent complications. Despite the similar tumor recurrence rates between the two approaches, the level of surgical completeness in ET may not be as good as that for OT.

Thyroid cancer surgery – in what direction are we going? A mini-review

“…16,17,34 Thus, several studies have demonstrated the superiority of scarless procedures over open surgery. 3,5,7,8,17,[29][30][31][32]34,35 However, the most certain advantage is the lack of a neck scar; the other clinical outcomes remain debatable. For example, the oncological safety of EBABA or TOETVA for patients with PTC is still unknown, and there is no worldwide consensus on this type of surgery for the treatment of this malignancy.…”

“…Because small PTCs, such as PTMCs, are treated by many surgeons via both endoscopic and robotic approaches, 3,7,8,19,24,27,28 many patients with larger tumors (>1.0 cm) undergo treatment with scarless surgical procedures. 16,17,19,34 Although OT is still one of the most common surgical procedures for treatment of thyroid gland pathologies, other techniques, such as ET and RT, have been gaining ground.…”

Surgical management of papillary thyroid cancer: review of current evidence and consensus

“…Despite the experience gained using such techniques in thyroid surgery, the utility in PTC remains controversial. A systematic review and meta-analysis by Chen et al (33) showed that there are limitations in endoscopic surgery due to the difficulty in obtaining views in the restricted space. Furthermore, endoscopic techniques were inferior in terms of operative time, hospital stay and transient recurrent laryngeal nerve palsy.…”

“…Furthermore, endoscopic techniques were inferior in terms of operative time, hospital stay and transient recurrent laryngeal nerve palsy. Moreover, despite similar tumour recurrence rates in the short and medium-term, the surgical completeness which may not be optimal could potentially lead to higher longer-term recurrences (33).…”

Long non‑coding RNA BRM promotes proliferation and invasion of papillary thyroid carcinoma by regulating the microRNA‑331‑3p/SLC25A1 axis

“…In 2018, thyroid cancer was the most common thyroid malignancy, accounting for ~1% of all malignant tumors, and includes papillary, follicular, undifferentiated and medullary carcinomas (1). Thyroid cancer occurs mostly in young adults aged ~40 years, and the ratio men to women is 1.0:2.5 to 1.0:3.0 (2).…”