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.	吳國洋, 林福生. 經口腔鏡甲狀腺手術的發展現狀與思考. 中華外科雜志, 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, 吳軍, 劉春生, 等. 經口腔前庭內鏡下甲狀腺癌根治術. 新疆醫科大學學報, 2018, 41(11): 1388-1390, 1395.
18.	彭亞, 柳岸, 彭小偉. 經口腔前庭內鏡甲狀腺癌切除術治療甲狀腺癌的臨床療效. 癌癥進展, 2019, 17(13): 1531-1533.
19.	許志亮, 譚玲珍, 宋俊龍, 等. 腔鏡與傳統開放手術治療甲狀腺微小乳頭狀癌的手術效果比較. 臨床外科雜志, 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.	趙蕾, 李進義, 王存川. 經口入路腔鏡甲狀腺切除術的研究進展. 中華外科雜志, 2014, 52(7): 541-543.
24.	吳楊, 易石堅, 王存川, 等. 經口腔入路腔鏡甲狀腺手術的效果. 中南醫學科學雜志, 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.	王錫山. 結直腸腫瘤類-NOTES手術實踐與關鍵技術. 中華普外科手術學雜志 (電子版), 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. 吳國洋, 林福生. 經口腔鏡甲狀腺手術的發展現狀與思考. 中華外科雜志, 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, 吳軍, 劉春生, 等. 經口腔前庭內鏡下甲狀腺癌根治術. 新疆醫科大學學報, 2018, 41(11): 1388-1390, 1395.
18. 彭亞, 柳岸, 彭小偉. 經口腔前庭內鏡甲狀腺癌切除術治療甲狀腺癌的臨床療效. 癌癥進展, 2019, 17(13): 1531-1533.
19. 許志亮, 譚玲珍, 宋俊龍, 等. 腔鏡與傳統開放手術治療甲狀腺微小乳頭狀癌的手術效果比較. 臨床外科雜志, 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. 趙蕾, 李進義, 王存川. 經口入路腔鏡甲狀腺切除術的研究進展. 中華外科雜志, 2014, 52(7): 541-543.
24. 吳楊, 易石堅, 王存川, 等. 經口腔入路腔鏡甲狀腺手術的效果. 中南醫學科學雜志, 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. 王錫山. 結直腸腫瘤類-NOTES手術實踐與關鍵技術. 中華普外科手術學雜志 (電子版), 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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