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Ambulatory Endoscopic Thyroidectomy via a Chest-Breast Approach Has an Acceptable Safety Profile for Thyroid Nodule.

ABSTRACT:

Introduction

With the growing esthetic requirements, endoscopic thyroidectomy develops rapidly and is widely accepted by practitioners and patients to avoid the neck scar caused by open thyroidectomy. Although ambulatory open thyroidectomy is adopted by multiple medical centers, the safety and potential of ambulatory endoscopic thyroidectomy via a chest-breast approach (ETCBA) is poorly investigated.

Material and methods

Patients with thyroid nodules who received conventional or ambulatory ETCBA at Xiangya hospital, Central South University from January 2017 to June 2020 were retrospectively included. The incidence of postoperative complications, 30-days readmission rate, financial cost, duration of hospitalization, mental health were mainly investigated.

Results

A total of 260 patients were included with 206 (79.2%) suffering from thyroid carcinoma, while 159 of 260 received ambulatory ETCBA. There was no statistically significant difference in the incidence of postoperative complications (P=0.249) or 30-days readmission rate (P=1.000). In addition, The mean economic cost of the ambulatory group had a 29.5% reduction compared with the conventional group (P<0.001). Meanwhile, the duration of hospitalization of the ambulatory group was also significantly shorter than the conventional group (P<0.001). Patients received ambulatory ETCBA showed a higher level of anxiety (P=0.041) and stress (P=0.016). Subgroup analyses showed consistent results among patients with thyroid cancer with a 12.9% higher complication incidence than the conventional ETCBA (P=0.068).

Conclusion

Ambulatory ETCBA is as safe as conventional ETCBA for selective patients with thyroid nodules or thyroid cancer, however with significant economic benefits and shorter duration of hospitalization. Extra attention should be paid to manage the anxiety and stress of patients who received ambulatory ETCBA.

SUBMITTER: Zhang Z

PROVIDER: S-EPMC8721221 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND: Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope, in a closed area maintained by insufflation or mechanical retraction. ET by direct cervical approach (anterior or lateral) is minimally invasive, but ET using an extracervical access (chest wall, breast, or axillary) is not. No technique seems to be universally accepted yet. This review was designed to clarify the existing evidence for performing endoscopic thyroid resections in the management of benign thyroid nodules. METHODS: A database search was conducted in PubMed and Embase from which summaries and abstracts were screened for relevant data, matching our definition. Publications were further assessed and assigned their respective levels of evidence. Additional data derived from our own unit's experience with endoscopic thyroidectomy were included. RESULTS: Thirty mainly retrospective cohort studies have been published in which morbidity, such as unilateral vocal cord palsy, is poorly evaluated. ET takes from 90 to 280 minutes for lobectomy by cervical access and total thyroidectomy by chest wall approach, respectively. Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach. Extracervical approach avoids a neck scar but implies invasiveness in terms of dissection and postoperative discomfort. Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published. CONCLUSIONS: Currently it is not possible to recommend the application of ET based on evidence. Reported complications stress the importance of advanced endoscopic skills. ET should only be offered to carefully selected patients and, therefore, a high volume of patients requiring thyroid surgery is needed. Superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. Possible advantages of endoscopic thyroid techniques and our patient's desire for the highest cosmetic outcome possible justify further development of ET in expert hands of endocrine surgeons.

Project description:While the thyroid has the capacity to grow in response to a stimulus that perturbs the pituitary-thyroid axis, cells involved in this process have not been well characterized. In this study, partial thyroidectomy was used to produce regeneration. Histological and gene profiling analyses were carried out using normal mouse thyroid as well as those after partial thyroidectomy. In the central area of the right or left normal thyroid lobe, a proliferative center was found with the occasional presence of micro-follicles, where BrdU-positive and/or C cells were mainly localized. Two weeks after partial thyroidectomy, the number of BrdU-positive cells and cells with clear or faintly eosionphilic cytoplasm, markedly increased in the central area of the thyroid lobe and the overlapping area close to the cutting edge. Clear-looking cells had scant cytoplasmic components as determined by electron microscopy; some retained characteristic features of C cells such as the presence of neuroendocrine granules while others retained follicular cell specific features such as those directly facing a lumen with microvilli at the apical side of the cell. Some of the clear-looking cells were BrdU-positive and expressed FOXA2, the definitive endoderm lineage marker. Microarray analysis further revealed that partial thyroidectomy affected the expression pattern of genes involved in cellular and/or metabolic process and their regulation categorized as Endocrine System Disorders and Embryonic Development, by Pathway analysis. These results suggest that cells previously C cells and/or follicular cells may be altered after partial thyroidectomy to become immature cells that participate in the repair and/or regeneration of the thyroid, a process similar to embryonic thyroid development. Total RNAs used for microarray analysis were prepared from laser capture microdissected mouse thyroids of the central (C) and peripheral (P) areas before (N: normal) and after (D: dissected) partial thyroidectomy. The RNAs obtained were first amplified, which were then subjected to hybridization using 5 NC (central area of the right or left lobe of normal thyroid), 3 NP (peripheral area of the right or left lobe of normal thyroid), 5DC (central area of the right or left lobe of dissected thyroid), 5 DP (peripheral area of the right or left lobe of dissected thyroid), and universal mouse RNAs as a reference. The 4-way analysis was carried out: NC vs NP vs DC vs DP.