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. 2018 Dec 5:14:2349-2361.
doi: 10.2147/TCRM.S183612. eCollection 2018.

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

Cong Chen  1   2 , Shumin Huang  3 , Aihua Huang  1   2 , Yunlu Jia  1   2 , Ji Wang  1   2 , Misha Mao  1   2 , Jichun Zhou  1   2 , Linbo Wang  1   2
Affiliations

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

Cong Chen et al. Ther Clin Risk Manag. .

Abstract

Background: Despite 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.

Methods: A 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.

Results: Twelve 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.

Conclusion: ET 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.

Keywords: conventional open thyroidectomy; endoscopic thyroidectomy; meta-analysis; papillary thyroid carcinoma.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram for study selection. Abbreviation: FTC, follicular thyroid cancer.
Figure 2
Figure 2
Forest plot and meta-analysis of (A) operative time; (B) number of retrieved lymph nodes; (C) blood loss. Abbreviations: ET, endoscopic thyroidectomy; OT, open thyroidectomy.
Figure 3
Figure 3
Forest plot and meta-analysis of (A) duration of drainage; (B) volume of drainage; (C) hospitalization period. Abbreviations: ET, endoscopic thyroidectomy; OT, open thyroidectomy.
Figure 4
Figure 4
Forest plot and meta-analysis of (A) transient RLN palsy; (B) permanent RLN palsy; (C) transient hypocalcemia; (D) permanent hypocalcemia; (E) hematoma or bleeding; (F) seroma. Abbreviations: ET, endoscopic thyroidectomy; M–H, Mantel–Haenszel; OT, open thyroidectomy; RLN, recurrent laryngeal nerve.
Figure 4
Figure 4
Forest plot and meta-analysis of (A) transient RLN palsy; (B) permanent RLN palsy; (C) transient hypocalcemia; (D) permanent hypocalcemia; (E) hematoma or bleeding; (F) seroma. Abbreviations: ET, endoscopic thyroidectomy; M–H, Mantel–Haenszel; OT, open thyroidectomy; RLN, recurrent laryngeal nerve.
Figure 5
Figure 5
Forest plot and meta-analysis of (A) number of sTg <1 ng/mL; (B) number of tumor recurrences. Abbreviations: ET, endoscopic thyroidectomy; M–H, Mantel–Haenszel; OT, open thyroidectomy; sTg, stimulated thyroglobulin.
Figure 6
Figure 6
Funnel plot of transient recurrent laryngeal nerve palsy in all included studies.
See this image and copyright information in PMC

References

    1. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140(4):317–322. - PubMed
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. - PubMed
    1. Shore SL. Thyroid Cancer Pathology. In: Vinjamuri S, editor. PET/CT in Thyroid Cancer. Cham: Springer; 2018. pp. 9–13.
    1. 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. - PubMed
    1. Hüscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc. 1997;11(8):877. - PubMed