Supraclavicular Approach of Lobectomy Improves Quality of Life for Patients With Unilateral Papillary Thyroid Microcarcinoma: A Prospective Cohort Study

Effects of Different Levels of Surgical Separation on Neck Bulge and Swallowing Disorders during Endoscopic Thyroidectomy

OBJECTIVE

Our study aims to compare the effects of different levels of access on postoperative neck bulge and swallowing disorder and provide a better level for endoscopic thyroidectomy.

MATERIALS AND METHODS

The patients were selected retrospectively between March 2021 to September 2021 by the Department of Thyroid Surgery, Third Affiliated Hospital of Zunyi Medical University. They were divided into two groups according to the level of the free flap during surgery: group A (the superficial cervical fascial level) and group B (the superficial deep cervical fascial level). Age, sex, body mass index, diameter of the primary lesion, postoperative neck bulge, and swallowing disorders and other complications were compared between the two groups.

RESULTS

A total of 40 patients who underwent endoscopic unilateral lobectomy plus central region lymph node dissection were enrolled in our study. Twenty in group A and 20 in group B. The age, gender, body mass index, diameter, and the proportion of benign and malignant primary lesions were not significantly different between the two groups ( P >0.05), and there was also no difference in thyroid function between the two groups ( P >0.05). No significant differences were observed in terms of bleeding and operation time during the operation ( P >0.05). There were also no statistical differences in terms of recurrent laryngeal nerve injury or hypoparathyroidism ( P >0.05). However, patients in group B were superior to those in group A in the occurrence of neck bulge and swallowing disorders ( P <0.05). These symptoms were most evident one month after surgery. Six months after the operation, only 4 patients in group B still complained of neck "swelling" and uncomfortable straining which did not resolve until 1 year after the operation. No statistical significance between long-term results and complication rates could be observed in either group.

CONCLUSION

In endoscopic thyroidectomy, the superficial cervical fascial level may be a better option for reducing postoperative neck bulge and swallowing disorders, which needs further validation by conducting a large sample study.

Comparisons of different approaches and incisions of thyroid surgery and selection strategy

To date, the traditional open thyroid surgery via a low collar incision remains the standard approach for patients undergoing thyroidectomy. However, this conventional approach will inevitably leave patients a neck scar and even cause a variety of complications such as paresthesia, hypesthesia, and other uncomfortable sensations. With the progress in surgical techniques, especially in endoscopic surgery, and the increasing desire for cosmetic and functional outcomes, various new approaches for thyroidectomy have been developed to avoid or decrease side effects. Some of these alternative approaches have obvious advantages compared with traditional surgery and have already been widely used in the treatment of thyroid disease, but each has its limitations. This review aims to evaluate and compare the different approaches to thyroidectomy to help surgeons make the proper treatment strategy for different individuals.

Advantages of Small Incision Surgery in Thyroid Tumors

Objective

Thyroid tumor is a common thyroid disease, and the incidence of complications after traditional thyroid surgery is high, which seriously affects the prognosis of patients. With the development of minimally invasive techniques, small incision surgery has a positive impact on changing the traditional thyroid surgery treatment. However, the gap between small incision surgery and traditional thyroid surgery is unclear, so this meta-analysis was used to evaluate its application value.

Methods

Searching English biomedical databases, including PubMed and Science Network and Chinese major biomedical databases, including CNKI, Wanfang, and Weipu. The keywords of the searched articles are as follows: small incision surgery, traditional thyroid surgery, thyroid tumor treatment, clinical efficacy of thyroid tumor, and surgical treatment, and these keywords are searched individually or in combination to track relevant systematic reviews and literature meta-analysis, and conduct other studies. The retrieval period is from the establishment of the database to January 2022. After extracting the article data, the patients were divided into small incision surgery group and traditional thyroid surgery group due to different intervention methods. The Cochrane risk of bias tool was used to assess the quality of the included literature, and RevMan 5.30 was used for meta-analysis.

Results

A total of 9 articles met the inclusion criteria. There were 369 patients with small incision surgery and 364 patients with traditional thyroid surgery. Compared with traditional thyroid surgery, patients treated with small incision surgery had significant short hospitalization time (MD −2.72, 95% CI (−3.32, −2.12)), less amount of bleeding (MD −15.52, 95% CI (−20.40, −10.65)), short incision length (MD −12.73, 95% CI (−16.29, −9.17)), lower VAS score (MD −2.58, 95% CI (−4.08, −1.08)), and less complications (RR 0.30, 95% CI (0.21, 0.44)).

Conclusion

Compared with traditional thyroid surgery, the results show that small incision surgery can shorten the hospital stay of patients with thyroid tumor, reduce the length of incision, reduce the amount of bleeding and the occurrence of complications, reduce postoperative pain, and have a positive effect on postoperative survival of patients.