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Chen L, He Q, Tian H, Zhu Q, Shen Y, Fang Y, Zhu F, Zhu L, Chen L, Pan J, Du Y, Yan X, Zhang Q, Zhou X, Tian W, Wu Y. Sternomastoid intermuscular approach has better postoperative cosmesis and less neck discomfort than linea alba cervicalis approach in hemithyroidectomy: a randomized clinical trial. Int J Surg 2023; 109:2672-2679. [PMID: 37379168 PMCID: PMC10498877 DOI: 10.1097/js9.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Surgery is still the most important treatment method for thyroid cancer. The classic linea alba cervicalis approach caused obvious neck scarring. This study explored an alternative open operative approach with concealed incision for hemithyroidectomy, and demonstrated whether it was non-inferior to traditional approach in postoperative complications and operation efficiency. METHODS Patients ( n =220) from November 2019 to November 2020 willing to undergo hemithyroidectomy because of differentiated thyroid cancer were randomly divided into the sternocleidomastoid intermuscular approach (SMIA) group ( n =110), and the linea alba cervicalis approach (LACA) group ( n =110). The incidence of postoperative complications within 3 months and operation efficiency indicator R0 resection rate were recorded as primary endpoint, while scar apperance was assessed as secondary endpoint. The data were statistically analyzed. RESULTS The baseline data of these two groups were comparable, with no significant difference ( P >0.05). As primary endpoint, R0 resection rate was 100% in both groups. In the 1-month follow-up period, the SMIA group had a lower score for neck discomfort compared with that of the LACA group (1.01±0.1648 vs. 0.5657±0.0976, P =0.0217). The SMIA group's scar had better results from the observer scar assessment compared to that of the LACA group as secondary endpoint. Within the 3-month follow-up, the total complications were calculated, and it was demonstrated that SMIA was non-inferior to traditional LACA operation ( P of non-inferiority=0.0048). CONCLUSIONS Compared with LACA group, surgery through the SMIA is safe, effective, and has non-inferior postoperative complications. SMIA can be considered an alternative approach to classic LACA in hemithyroidectomy.
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Affiliation(s)
- Linghui Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qiwen He
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Hedi Tian
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qinsheng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yibin Shen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yun Fang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Feng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lixian Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Liang Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jun Pan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yehui Du
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiaochuan Yan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qijun Zhang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xueyu Zhou
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, P.R. China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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Jiang B, Qu C, Jiang C, Zhang C, Shen S, Luo Y, Su L. Comparison of Supraclavicular Oblique Incision With Traditional Low Collar Incision Approach for Thyroidectomy in Differentiated Thyroid Cancer. Front Oncol 2022; 12:842981. [PMID: 35372045 PMCID: PMC8964930 DOI: 10.3389/fonc.2022.842981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/09/2022] [Indexed: 12/29/2022] Open
Abstract
Background Various incisions and approaches for thyroidectomy have been developed to treat differentiated thyroid cancer (DTC). Supraclavicular oblique incision (SOI) thyroidectomy (SOIT) has been applied in DTC patients over the past ten years. However, the safety and efficacy of this approach were yet to be confirmed. Aim This study aimed to compare the surgical and patient-related outcomes between SOIT and traditional low collar incision thyroidectomy (TLCIT) in patients with DTC. Methods We retrospectively screened all patients with DTC who received thyroid lobectomy from October 2020 to October 2021. The surgical results and patient-related outcomes assessed at 1 and 6 months after surgery by questionnaire were compared between the SOIT and TLCIT groups. Results A total of 128 patients were included in this study, of whom 38 patients (30.5%) were operated on with SOIT and 89 patients (69.5%) with TLCIT. There was no significant difference in demographic characteristics and thyroid features between the two groups. Despite comparable operative time (61.9 ± 12.1 vs. 59.9 ± 15.0 min, p = 0.425), the SOIT group had a smaller neck incision (4.4 ± 0.7 vs. 5.0 ± 1.0 cm, p = 0.002), a shorter duration of postoperative drainage (2.4 ± 0.5 vs. 2.7 ± 0.9 days, p = 0.019), less volume of postoperative drainage (48.4 ± 24.6 vs. 60.3 ± 22.8 ml, p = 0.040), and shorter postoperative hospitalization (3.2 ± 0.5 vs. 3.6 ± 0.9 days p = 0.006), as compared with the TLCIT group. At 1-month follow-up after surgery, SOIT showed better performance in preventing hypoparathyroidism (p = 0.026) and abnormal neck sensation (p = 0.010) and in improving cosmetic satisfaction (p = 0.036) than TLCIT. At 6-month follow-up, SOIT was feedback with better cosmetic satisfaction (p < 0.001) and a lower percent of abnormal neck sensation (p = 0.031) or movement (p = 0.005). Conclusion Our study suggests that minimally invasive surgery using the SOI provides superior surgical and patient-related outcomes compared with surgery using a traditional low collar incision (TLCI) in patients with DTC.
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Affiliation(s)
- Bo Jiang
- Department of General Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Cheng Qu
- Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chaoyu Jiang
- Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chen Zhang
- Department of General Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Song Shen
- Department of Cardiology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuqian Luo
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lei Su
- Department of General Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Ren YX, Yang J, Sun WZ, Chen Y, Wu XF, Huang N, Li XJ. Application of lateral supraclavicular incision in unilateral thyroid papillary carcinoma surgery. Braz J Otorhinolaryngol 2021; 88 Suppl 1:S42-S47. [PMID: 34119426 PMCID: PMC9734257 DOI: 10.1016/j.bjorl.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The standard approach to thyroidectomy is a collar incision via the anterior neck, and the neck scar has always been a source of worry for patients. Acceptable wound cosmetology has become a focus for thyroid surgeons. OBJECTIVE To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. METHODS 180 patients were randomly divided into two groups: a lateral supraclavicular approach and a conventional transcervical approach. The main outcomes included incision length, intraoperative blood loss, operative time, total drainage volume, hospitalization expense, early postoperative pain measured by visual analog scale, infection, and perceived cosmetic outcome. RESULTS There were no statistical significances between the two groups in terms of age, gender, nodule size, intraoperative blood loss, operative time, total drainage volume, hospital expense and postoperative complications, whereas there were significant differences in terms of incision length (5.2±1.04cm vs. 6.9±1.14cm, p<0.05). CONCLUSIONS The lateral supraclavicular incision is a safe and feasible approach for thyroidectomy. Compared with conventional approach, it provides a better cosmetic result.
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Affiliation(s)
- Yan-Xin Ren
- Kunming Medical University, Third Affiliated Hospital, Kunming, China
| | - Jie Yang
- Kunming Medical University, Third Affiliated Hospital, Kunming, China
| | - Wei-Ze Sun
- Kunming Medical University, Third Affiliated Hospital, Kunming, China
| | - Yun Chen
- Kunming Medical University, Third Affiliated Hospital, Department of Pathology, Kunming, China
| | - Xi-Fang Wu
- Kunming Medical University, Third Affiliated Hospital, Kunming, China
| | - Ning Huang
- Kunming Medical University, Department of Pharmacology, Kunming, China.
| | - Xiao-Jiang Li
- Kunming Medical University, Third Affiliated Hospital, Kunming, China.
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Xue S, Wang Q, Chen G, Wang P, Zhang L. Supraclavicular Approach of Lobectomy Improves Quality of Life for Patients With Unilateral Papillary Thyroid Microcarcinoma: A Prospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:766444. [PMID: 35058877 PMCID: PMC8764192 DOI: 10.3389/fendo.2021.766444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Postoperative neck symptoms, including pain, swelling, uncomfortable feelings during swallowing, and incision adhesion formation, are common in patients after lobectomy through the traditional middle neck approach. A new unilateral supraclavicular approach is proposed to protect the anterior cervical region and reduce related complications. The aim of this study is to investigate the efficacy, safety, and advantages of the supraclavicular approach in lobectomy for unilateral papillary thyroid microcarcinoma (PTMC). METHODS Two hundred sixty-three patients were recruited into either a conventional middle group (CM) or a new supraclavicular (NS) group. Clinicopathological features, surgically related variables, and postoperative symptoms were recorded. Quality of life (QOL) of all patients was assessed by the 12-item short-form health survey (SF-12) and thyroid cancer-specific QOL (THYCA-QoL) questionnaire in 3 and 12 months. RESULTS There were no statistically significant differences in clinicopathological features (including sex, age, multifocality, extrathyroidal extension, histological variants, largest tumor diameter, Hashimoto's thyroiditis, metastasized central lymph node, removed central lymph node, surgeon, BRAF mutation, and follow-up duration), hospitalization (including hospital cost, surgery time, and blood loss during surgery), and complications between the two groups. Patients who underwent lobectomy through the NS approach had significantly better SF-12 physical, mental, and THYCA-QoL than the CM group patients in both 3 and 12 months (all p < 0.001). Moreover, the NS group had a shorter hospitalization time. CONCLUSION In conclusion, the NS approach for lobectomy is a safe and effective method for reducing postoperative symptoms and increasing QOL in patients with unilateral PTMC in both 3 and 12 months' follow-up.
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Affiliation(s)
- Shuai Xue
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Qiuli Wang
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Guang Chen
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
- *Correspondence: Li Zhang, ; Guang Chen,
| | - Peisong Wang
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Nephrology, The 1st Hospital of Jilin University, Changchun, China
- *Correspondence: Li Zhang, ; Guang Chen,
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Yang YL, Xiang YY, Jin LP, Pan YF, Zhou SM, Zhang XH, Qu JM. Closure of skin incision after thyroidectomy through a supraclavicular approach: a comparison between tissue adhesive and staples. Scand J Surg 2013; 102:234-40. [PMID: 24056141 DOI: 10.1177/1457496913490610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The objective of this study was to compare the effectiveness and cosmetic results of tissue adhesive or surgical staples in thyroidectomy through a supraclavicular incision. Methods: This was a prospective, randomized study of consecutive patients undergoing thyroidectomy by a supraclavicular approach. Eligible patients were randomized into two groups: one group had the incision closed with tissue adhesive (the experimental group) and the other with surgical staples (the control group). The main outcomes included operative time, early postoperative pain measured by Visual Analog Scale, incidence of wound dehiscence and infection, perceived cosmetic outcome, and overall patient satisfaction by using Patient Satisfaction Assessment Form. Results: There were 151 consecutive patients assessed for eligibility, and 132 patients were enrolled over 22 months. The clinical characteristics of the patients in the two groups were similar. Main outcomes were assessed in the first 24 h postoperatively, the first month, and the third month postoperatively. Operation time was longer in the experimental group ( P = 0.027). Mean Visual Analog Scale scores for pain were lower in the experimental group in the early postoperative period ( P < 0.001). No patients developed surgical site infections or wound dehiscence. Lower scores for scar assessment and higher overall satisfaction levels at the first month after surgery were found in the experimental group compared to the control group ( P < 0.001). There was no significant difference between the two groups at the third month postoperatively in perceived cosmetic result ( P = 0.052) or overall satisfaction ( P = 0.059). Conclusions: Tissue adhesive is effective and reliable in skin closure for thyroid surgery. While this closure may take somewhat longer to perform, it leads to less postoperative pain, more acceptable wound cosmesis, and higher patient satisfaction levels in short postoperative follow-up.
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Affiliation(s)
- Y.-L. Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - Y.-Y. Xiang
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - L.-P. Jin
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - Y.-F. Pan
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - S.-M. Zhou
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - X.-H. Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - J.-M. Qu
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
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