Background

Transoral endoscopic thyroid surgery via the vestibular approach (TOETVA) has been gradually accepted worldwide due to its scar-free effect on the neck. Even central cervical lymphadenectomy has been performed in some cases of papillary thyroid carcinoma (PTC). However, there are few reports involving lateral neck dissection with TOETVA. In this study, we attempted to perform selective lateral neck dissection (SLND) for PTC via a transoral vestibular approach.

Methods

This prospective study was conducted from January 2016 to December 2018 in twenty PTC patients with unilateral T1 tumors without capsular invasion and patients with abnormal level III and IV lymph nodes who underwent SLND via a transoral vestibular approach.

Results

Endoscopic surgery was successfully accomplished in all 20 PTC patients. The mean age was 29.2 ± 5.5 (20–41) years. The mean operation time was 146.0 ± 18.7 (114–193) min. The average postoperative hospital stay was 6.8 ± 1.3 (5–10) days. The mean number of removed nodes was 7.4 ± 2.5 (4–12) in the central neck and 10.9 ± 2.8 (6–16) in the lateral neck, and the positive yield amounts were 2.0 ± 1.2 (0–4) and 2.7 ± 1.9 (0–6), respectively. No major complications occurred except for 1 case of transient unilateral recurrent laryngeal nerve palsy and two cases of effusion in the operative area. No evidence of persistent or recurrent disease was observed in these patients during a mean follow-up of 24.3 ± 9.1 (6–36) months. The cosmetic results and protection of personal privacy of this procedure were excellent.

Conclusion

Endoscopic SLND via the transoral vestibular approach is feasible, safe, and effective for selected PTCs. A multicenter large comparative study is necessary.

中文翻译：

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经口内镜选择性颈旁淋巴结清扫术治疗甲状腺乳头状癌

背景

通过前庭入路的经口内镜甲状腺手术（TOETVA）由于其对颈部无疤痕的作用已被世界范围内逐渐接受。在某些甲状腺乳头状癌（PTC）病例中，甚至进行了中央颈淋巴结清扫术。但是，很少有报道涉及用TOETVA进行颈外侧解剖。在这项研究中，我们尝试通过经口前庭入路对PTC进行选择性侧颈清扫术（SLND）。

方法

这项前瞻性研究于2016年1月至2018年12月对20例无包膜浸润的PTC单侧T1肿瘤患者以及经经口前庭途径接受SLND的III级和IV级淋巴结异常的患者进行了研究。

结果

所有20例PTC患者均成功完成了内镜手术。平均年龄为29.2±5.5（20-41）岁。平均手术时间为146.0±18.7（114–193）分钟。术后平均住院天数为6.8±1.3（5-10）天。中央颈部的平均切除结节数为7.4±2.5（4–12），外侧颈部的平均切除结节数为10.9±2.8（6–16），正屈服量为2.0±1.2（0–4）和2.7±分别为1.9（0–6）。除1例短暂性单侧复发性喉神经麻痹和2例手术部位积液外，未发生任何重大并发症。在平均24.3±9.1（6–36）个月的平均随访期间，这些患者未观察到持续性或复发性疾病的证据。该程序的美容效果和对个人隐私的保护都非常出色。

结论

经口前庭入路的内镜SLND对某些PTC而言是可行，安全且有效的。需要进行多中心的大型比较研究。