Minimally Invasive Open Bilateral Total Thyroidectomy Using Unilateral Neck Incision in Thyroid Cancer: Preliminary Surgical and Quality of Life Outcomes
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Thyroid cancer incidence has increased in recent decades, and thyroid surgery is continuously evolving in response to demands for postoperative comfort and cosmesis. This study aimed to introduce a new surgical method for minimally invasive open bilateral total thyroidectomy (MI-BTT) using a unilateral 2.5–3.0 cm neck incision. Furthermore, we reported the surgical outcomes and postoperative quality of life (QoL) using a validated Korean translated Dermatology Life Quality Index (DLQI) questionnaire. Materials and Methods: We retrospectively evaluated 41 Asian patients who underwent MI-BTT for low-risk papillary thyroid cancer by a single surgeon from March 2019 to December 2021. Results: A total of 4 male and 37 female patients were included. The mean age and body mass index were 46.2±10.1 years and 23.3±3.3 kg/m2, respectively. The average tumor size was 1.1±0.6 cm, and 36 patients (87.8%) had bilateral cancer. Twenty-three (56.1%) patients had occult central lymph node (CLN) metastasis in the final pathologic report, with the mean number of dissected CLNs being 7.2±6.5. Gross capsular extension was found in 6 patients (14.6%). Moreover, 28 patients (68.3%) received additional treatment after surgery with low or high doses of radioactive iodine. The average serum-stimulated thyroglobulin value identified during treatment was 1.57±2.30 ng/mL. The mean operation time was 78.0±13.9 minutes, and postoperative complications included transient hypocalcemia (36.6%), transient hoarseness (24.4%), and seroma (2.4%). The mean total DLQI score was 2.73±0.78, indicating a small effect on QoL. Conclusion: MI-BTT is a novel, safe, and feasible technique to improve patient satisfaction for surgical scars and QoL.
Abstract
Purpose: Thyroid cancer incidence has increased in recent decades, and thyroid surgery is continuously evolving in response to demands for postoperative comfort and cosmesis. This study aimed to introduce a new surgical method for minimally invasive open bilateral total thyroidectomy (MI-BTT) using a unilateral 2.5–3.0 cm neck incision. Furthermore, we reported the surgical outcomes and postoperative quality of life (QoL) using a validated Korean translated Dermatology Life Quality Index (DLQI) questionnaire. Materials and Methods: We retrospectively evaluated 41 Asian patients who underwent MI-BTT for low-risk papillary thyroid cancer by a single surgeon from March 2019 to December 2021. Results: A total of 4 male and 37 female patients were included. The mean age and body mass index were 46.2±10.1 years and 23.3±3.3 kg/m2, respectively. The average tumor size was 1.1±0.6 cm, and 36 patients (87.8%) had bilateral cancer. Twenty-three (56.1%) patients had occult central lymph node (CLN) metastasis in the final pathologic report, with the mean number of dissected CLNs being 7.2±6.5. Gross capsular extension was found in 6 patients (14.6%). Moreover, 28 patients (68.3%) received additional treatment after surgery with low or high doses of radioactive iodine. The average serum-stimulated thyroglobulin value identified during treatment was 1.57±2.30 ng/mL. The mean operation time was 78.0±13.9 minutes, and postoperative complications included transient hypocalcemia (36.6%), transient hoarseness (24.4%), and seroma (2.4%). The mean total DLQI score was 2.73±0.78, indicating a small effect on QoL. Conclusion: MI-BTT is a novel, safe, and feasible technique to improve patient satisfaction for surgical scars and QoL.
참고문헌 (28)
- Hollinshead WH, "Anatomy of the endocrine glands", Surg Clin North Am, 32, pp.1115~1140 (1952)
- Shuja A, "History of thyroid surgery", Professional Med J, 15, pp.295~297 (2008)
- Welbourn RB, "Highlights from endocrine surgical history", World J Surg, 20, pp.603~612 (1996)
- Lirici MM, "Endoscopic right thyroid lobectomy", Surg Endosc, 11, pp.877~ (1997)
- Jiang WJ, "Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer : a systematic review and meta-analysis", Surg Endosc, 34, pp.1891~1903 (2020)
- Wang Y, "Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy : meta-analysis", Head Neck, 43, pp.345~353 (2021)
- Camenzuli C, "Transoral endoscopic thyroidectomy : a systematic review of the practice so far", JSLS, 22, pp.e2018.00026~ (2018)
- Lee J, "Differences in postoperative outcomes, function, and cosmesis : open versus robotic thyroidectomy", Surg Endosc, 24, pp.3186~3194 (2010)
- Shan L, "Meta-analysis comparison of bilateral axillo-breast approach robotic thyroidectomy and conventional thyroidectomy", Surg Innov, 26, pp.112~123 (2019)
- Lee IA, "Comparison of surgical outcomes between robotic transaxillary and conventional open thyroidectomy in pediatric thyroid cancer", Cancers(Basel), 13, pp.3293~ (2021)
- Lee J, "Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma : a multicenter study", Surg Endosc, 25, pp.906~912 (2011)
- Rossi L, "Postsurgical complications after robot-assisted transaxillary thyroidectomy : critical analysis of a large cohort of European patients", Updates Surg, 74, pp.511~517 (2022)
- Jackson NR, "Safety of robotic thyroidectomy approaches : meta-analysis and systematic review", Head Neck, 36, pp.137~143 (2014)
- Son SK, "Surgical safety and oncologic effectiveness in robotic versus conventional open thyroidectomy in thyroid cancer : a systematic review and meta-analysis", Ann Surg Oncol, 22, pp.3022~3032 (2015)
- Park CS, "Minimally invasive open thyroidectomy", Surg Today, 31, pp.665~669 (2001)
- Brown BC, "The hidden cost of skin scars : quality of life after skin scarring", J Plast Reconstr Aesthet Surg, 61, pp.1049~1058 (2008)
- Shin JH, "Ultrasonography diagnosis and imaging-based management of thyroid nodules : revised Korean Society of Thyroid Radiology consensus statement and recommendations", Korean J Radiol, 17, pp.370~395 (2016)
- Haugen BR, "2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer : the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer", Thyroid, 26, pp.1~133 (2016)
- Kim K, "Surgical outcomes of minimally invasive thyroidectomy in thyroid cancer : comparison with conventional open thyroidectomy", Gland Surg, 9, pp.1172~1181 (2020)
- Hongbo Y, "Translating the science of quality of life into practice : what do dermatology life quality index scores mean?", J Invest Dermatol, 125, pp.659~664 (2005)
- Vaccarella S, "Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis", N Engl J Med, 375, pp.614~617 (2016)
- Pizzato M, "The epidemiological landscape of thyroid cancer worldwide : GLOBOCAN estimates for incidence and mortality rates in 2020", Lancet Diabetes Endocrinol, 10, pp.264~272 (2022)
- Ferzli GS, "Minimally invasive, nonendoscopic thyroid surgery", J Am Coll Surg, 192, pp.665~668 (2001)
- Sackett WR, "Minimal access thyroid surgery: is it feasible, is it appropriate?", ANZ J Surg, 72, pp.777~780 (2002)
- Cavicchi O, "Minimally invasive nonendoscopic thyroidectomy", Otolaryngol Head Neck Surg, 135, pp.744~747 (2006)
- Hyun K, "Comparison of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy", Surg Endosc, 28, pp.1914~1920 (2014)
- Choi Y, "Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients", Ann Dermatol, 26, pp.693~699 (2014)
- Kim SY, "Modified version of minimally invasive open thyroidectomy using an unilateral incision", Asian J Surg, 44, pp.1166~1171 (2021)