Efficacy comparison of transoral endoscopic thyroidectomy vestibular approach <i>vs</i> conventional open thyroidectomy for differentiated thyroid carcinoma: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XUE Jingyi ¹ , HU Xi’e ² , TANG Haili ² ,  BAO Guoqiang ²

1. The Second Clinical Medical College of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi 712000, P. R. China;
2. Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi’an 710038, P. R. China;

Corresponding author：

BAO Guoqiang, Email: guoqiang@fmmu.edu.cn

Keywords：

differentiated thyroid cancer; transoral endoscopic thyroidectomy vestibular approach; conventional open thyroidectomy; meta-analysis

DOI：

10.7507/1007-9424.202004061

Video：

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Objective To systematically evaluate the reliability and stability of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and conventional open thyroidectomy (COT) in the treatment of differentiated thyroid cancer.Methods The clinical studies of TOETVA and COT in the treatment of differentiated thyroid cancer were retrieved from major databases including PubMed, Embase, Cochrane Library, Wanfang, and CNKI by computer. The search date ended on March 1, 2020. Two investigators screened the literatures strictly and extracted the data following the pre-defined inclusion and exclusion criteria, and then used RevMan 5.3 software for meta-analysis.Results A total of 7 studies including 1 465 patients were included in this meta-analysis. The results showed: compared with the COT group, the operation time of the TOETVA group was longer [WMD=35.18, P=0.000 1], and the number of lymph node dissections in the central area was larger [WMD=1.42, P=0.000 5]. But the intraoperative blood loss [WMD=–5.32, P=0.39], the length of hospital stay after operation [WMD=0.05, P=0.94], the incidences of transient recurrent laryngeal nerve palsy [OR=0.81, P=0.43], transient hypocalcemia [OR=0.55, P=0.35], permanent hypocalcemia [OR=0.39, P=0.22], permanent recurrent laryngeal nerve palsy [OR=1.34, P=0.73], and hematoma [OR=1.29, P=0.69] were not statistically significant between the two groups.Conclusions TOETVA has a higher stability. Although the COT has a shorter operation time, the former has a higher central lymph node dissection rate, and there is no scar on the neck after surgery and no significant difference in the incidence of postoperative complications.

Citation： XUE Jingyi, HU Xi’e, TANG Haili, BAO Guoqiang. Efficacy comparison of transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy for differentiated thyroid carcinoma: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(12): 1548-1555. doi: 10.7507/1007-9424.202004061 Copy

1.	Ikeda Y, Takami H, Sasaki Y, et al. Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg, 2004, 28(11): 1075-1078.
2.	Dorak MT, Karpuzoglu E. Gender differences in cancer susceptibility: an inadequately addressed issue. Front Genet, 2012, 3: 268.
3.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
4.	Tan CT, Cheah WK, Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg, 2008, 32(7): 1349-1357.
5.	Dionigi G, Boni L, Duran-Poveda M. Evolution of endoscopic thyroidectomy. Surg Endosc, 2011, 25(12): 3951-3952.
6.	Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg, 2016, 40(3): 491-497.
7.	Erol V, Dionigi G, Barczyński M, et al. Intraoperative neuromonitoring of the RLNs during TOETVA procedures. Gland Surg, 2020, 9(Suppl 2): S129-S135.
8.	Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg, 2017, 6(3): 277-284.
9.	吴国洋, 林福生. 经口腔镜甲状腺手术的发展现状与思考. 中华外科杂志, 2016, 54(11): 819-822.
10.	Dionigi G, Bacuzzi A, Lavazza M, et al. Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg, 2017, 69(2): 225-234.
11.	Udelsman R, Anuwong A, Oprea AD, et al. Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg, 2016, 264(6): e13-e16.
12.	Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol, 2013, 66(9): 982-993.
13.	Ahn JH, Yi JW. Correction to: transoral endoscopic thyroidectomy for thyroid carcinoma: outcomes and surgical completeness in 150 single-surgeon cases. Surg Endosc, 2020, 34(2): 868.
14.	Pérez-Soto RH, Ponce de León-Ballesteros G, Montalvo-Hernández J, et al. Transoral endoscopic thyroidectomy by vestibular approach-initial experience and comparative analysis in the first reported Mexican cohort. J Laparoendosc Adv Surg Tech A, 2019, 29(12): 1526-1531.
15.	Sun H, Zheng H, Wang X, et al. Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma. Surg Endosc, 2020, 34(1): 268-274.
16.	Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg, 2018, 153(1): 21-27.
17.	董朝, 吴军, 刘春生, 等. 经口腔前庭内镜下甲状腺癌根治术. 新疆医科大学学报, 2018, 41(11): 1388-1390, 1395.
18.	彭亚, 柳岸, 彭小伟. 经口腔前庭内镜甲状腺癌切除术治疗甲状腺癌的临床疗效. 癌症进展, 2019, 17(13): 1531-1533.
19.	许志亮, 谭玲珍, 宋俊龙, 等. 腔镜与传统开放手术治疗甲状腺微小乳头状癌的手术效果比较. 临床外科杂志, 2019, 27(11): 989-991.
20.	Wilhelm T, Metzig A. Video. Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc, 2010, 24(7): 1757-1758.
21.	Wilhelm T, Metzig A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg, 2011, 35(3): 543-551.
22.	Nakajo A, Arima H, Hirata M, et al. Trans-Oral Video-Assisted Neck Surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc, 2013, 27(4): 1105-1110.
23.	赵蕾, 李进义, 王存川. 经口入路腔镜甲状腺切除术的研究进展. 中华外科杂志, 2014, 52(7): 541-543.
24.	吴杨, 易石坚, 王存川, 等. 经口腔入路腔镜甲状腺手术的效果. 中南医学科学杂志, 2015, 43(6): 627-631.
25.	Tesseroli MAS, Spagnol M, Sanabria Á. Transoral endoscopic thyroidectomy by vestibular approach (TOETVA): initial experience in Brazil. Rev Col Bras Cir, 2018, 145(5): e1951.
26.	Fu J, Luo Y, Chen Q, et al. Transoral endoscopic thyroidectomy: review of 81 cases in a single institute. J Laparoendosc Adv Surg Tech A, 2018, 28(3): 286-291.
27.	Jitpratoom P, Ketwong K, Sasanakietkul T, et al. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy. Gland Surg, 2016, 5(6): 546-552.
28.	Shan L, Liu J. A systemic review of transoral thyroidectomy. Surg Laparosc Endosc Percutan Tech, 2018, 28(3): 135-138.
29.	You JY, Kim HY, Park DW, et al. Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching. Surg Endosc, 2020, [Online ahead of print].
30.	王锡山. 结直肠肿瘤类-NOTES手术实践与关键技术. 中华普外科手术学杂志 (电子版), 2016, 10(2): 94-96.

1. Ikeda Y, Takami H, Sasaki Y, et al. Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg, 2004, 28(11): 1075-1078.
2. Dorak MT, Karpuzoglu E. Gender differences in cancer susceptibility: an inadequately addressed issue. Front Genet, 2012, 3: 268.
3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
4. Tan CT, Cheah WK, Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg, 2008, 32(7): 1349-1357.
5. Dionigi G, Boni L, Duran-Poveda M. Evolution of endoscopic thyroidectomy. Surg Endosc, 2011, 25(12): 3951-3952.
6. Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg, 2016, 40(3): 491-497.
7. Erol V, Dionigi G, Barczyński M, et al. Intraoperative neuromonitoring of the RLNs during TOETVA procedures. Gland Surg, 2020, 9(Suppl 2): S129-S135.
8. Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg, 2017, 6(3): 277-284.
9. 吴国洋, 林福生. 经口腔镜甲状腺手术的发展现状与思考. 中华外科杂志, 2016, 54(11): 819-822.
10. Dionigi G, Bacuzzi A, Lavazza M, et al. Transoral endoscopic thyroidectomy: preliminary experience in Italy. Updates Surg, 2017, 69(2): 225-234.
11. Udelsman R, Anuwong A, Oprea AD, et al. Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg, 2016, 264(6): e13-e16.
12. Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol, 2013, 66(9): 982-993.
13. Ahn JH, Yi JW. Correction to: transoral endoscopic thyroidectomy for thyroid carcinoma: outcomes and surgical completeness in 150 single-surgeon cases. Surg Endosc, 2020, 34(2): 868.
14. Pérez-Soto RH, Ponce de León-Ballesteros G, Montalvo-Hernández J, et al. Transoral endoscopic thyroidectomy by vestibular approach-initial experience and comparative analysis in the first reported Mexican cohort. J Laparoendosc Adv Surg Tech A, 2019, 29(12): 1526-1531.
15. Sun H, Zheng H, Wang X, et al. Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma. Surg Endosc, 2020, 34(1): 268-274.
16. Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg, 2018, 153(1): 21-27.
17. 董朝, 吴军, 刘春生, 等. 经口腔前庭内镜下甲状腺癌根治术. 新疆医科大学学报, 2018, 41(11): 1388-1390, 1395.
18. 彭亚, 柳岸, 彭小伟. 经口腔前庭内镜甲状腺癌切除术治疗甲状腺癌的临床疗效. 癌症进展, 2019, 17(13): 1531-1533.
19. 许志亮, 谭玲珍, 宋俊龙, 等. 腔镜与传统开放手术治疗甲状腺微小乳头状癌的手术效果比较. 临床外科杂志, 2019, 27(11): 989-991.
20. Wilhelm T, Metzig A. Video. Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc, 2010, 24(7): 1757-1758.
21. Wilhelm T, Metzig A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg, 2011, 35(3): 543-551.
22. Nakajo A, Arima H, Hirata M, et al. Trans-Oral Video-Assisted Neck Surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc, 2013, 27(4): 1105-1110.
23. 赵蕾, 李进义, 王存川. 经口入路腔镜甲状腺切除术的研究进展. 中华外科杂志, 2014, 52(7): 541-543.
24. 吴杨, 易石坚, 王存川, 等. 经口腔入路腔镜甲状腺手术的效果. 中南医学科学杂志, 2015, 43(6): 627-631.
25. Tesseroli MAS, Spagnol M, Sanabria Á. Transoral endoscopic thyroidectomy by vestibular approach (TOETVA): initial experience in Brazil. Rev Col Bras Cir, 2018, 145(5): e1951.
26. Fu J, Luo Y, Chen Q, et al. Transoral endoscopic thyroidectomy: review of 81 cases in a single institute. J Laparoendosc Adv Surg Tech A, 2018, 28(3): 286-291.
27. Jitpratoom P, Ketwong K, Sasanakietkul T, et al. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy. Gland Surg, 2016, 5(6): 546-552.
28. Shan L, Liu J. A systemic review of transoral thyroidectomy. Surg Laparosc Endosc Percutan Tech, 2018, 28(3): 135-138.
29. You JY, Kim HY, Park DW, et al. Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching. Surg Endosc, 2020, [Online ahead of print].
30. 王锡山. 结直肠肿瘤类-NOTES手术实践与关键技术. 中华普外科手术学杂志 (电子版), 2016, 10(2): 94-96.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy comparison of transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy for differentiated thyroid carcinoma: a meta-analysis

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