Safety And Efficacy Of Endoscopy In The Treatment Of Papillary Thyroid Carcinoma

Background:Thyroid papillary carcinoma is a common type of thyroid cancer with a good prognosis.Surgery is the main treatment for papillary thyroid cancer,but an open surgery can leave a scar on the neck.As more and more young women are detected,patients are not only concerned about the effect of tumor treatment,but also the aesthetic effect after surgery.Therefore,thyroid surgeons should not only successfully treat the disease,but also take into account the postoperative quality of life and aesthetic effect of patients.In the 1990 s,endoscopic technique was applied to the treatment of benign thyroid diseases,and endoscopic thyroid surgery as a cosmetic surgery is favored by more and more patients.With the improvement of endoscopic technique and the improvement of instruments,endoscopic thyroid surgery has become more and more mature.In recent years,endoscopic surgery has been used in the treatment of low-grade papillary thyroid carcinoma,which meets the needs of these patients with cosmetic needs.However,the treatment of thyroid malignancy by total endoscopic surgery is controversial,and its safety and efficacy need to be further proved.Objective:We used this study to demonstrate the safety and effectiveness of endoscopic treatment of thyroid papillary carcinoma.Method:This study consists of two parts.We evaluated the safety and efficacy of endoscopy in the treatment of papillary thyroid carcinoma using retrospective studies and evidence-based medicine.The first part,in cooperation with the thyroid surgery department of southwest hospital of the army medical university,retrospectively analyzed the data of 1441 initially treated patients who underwent total thyroidectomy in the thyroid surgery department of southwest hospital of the army medical university from February 2016 to June 2019 and were pathologically confirmed as thyroid papillary carcinoma.Among them,1221 patients underwent traditional open surgery,and 220 patients underwent endoscopic thyroidectomy with axillo-breast approach or breast approach.The second part compares the systematic evaluation of the treatment of thyroid papillary carcinoma with total endoscopy and surgical operation.The role of evidence-based medicine is to guide the development of disease diagnosis and treatment plans,find the answers to the confused and problematic clinical problems in evidence-based medicine,and unify the understanding.Therefore,we performed a systematic review using a retrospective review to compare the safety and efficacy of traditional surgery versus total endoscopic surgery for the treatment of thyroid papillary carcinoma.Verify the results of clinical studies with the conclusion of evidence-based medicineresearch.Result:First,the mean age was 52.1 years who received a conventional thyroidectomy and 42.2 years in endoscopic thyroidectomy(P<0.05).The conventional thyroidectomy group underwent more extensive surgery than the endoscopic thyroidectomy group but the operation time was longer in the endoscopic thyroidectomy group(P<0.05).The mean hospitalization length was 4.0 days following open thyroidectomy and 5.9 days after endoscopic thyroidectomy(P<0.05).The tumorsize was larger in the conventional thyroidectomy group than the endoscopic thyroidectomy group and a lesser number of lymph nodes were retrieved in the endoscopic thyroidectomy group compared to the conventional thyroidectomy group(P<0.05).The postoperative complications and thyroglobulin levels in both groups were not significantly different.A lesser number of lymph nodes were retrieved in the endoscopic thyroidectomy group compared to the conventional thyroidectomy group(P<0.05).The thyroglobulin levels in both groups were not significantly different.The incidence of temporary postoperative hypocalcemia in COT group was higher than that in ABA or BA group(P<0.05),but there was no difference in the incidence of permanent hypocalcemia between the two groups.The incidence of recurrent laryngeal nerve palsy was higher in ABA or BA group than in COT group(P<0.05),and there was no statistical difference in permanent recurrent laryngeal nerve palsy.Postoperative sera were no different between the two groups.During postoperative follow-up,a total of 26 cases(1.8%)recurred.There were 22 cases(1.8%)in group A and 4 cases(1.8%)in group B.There was no difference in tumor recurrence or lymph node metastasis in the two groups.Second,the systematic review and meta-analysis were based on the 5664 cases selected from the twenty publications.TET was associated with an equivalent surgical completeness including postoperative TG levels,recurrence of the tumor after long-term follow-up,as well as equivalent adverse event and complication rate including transient recurrent laryngeal nerve(RLN)palsy,permanent RLN palsy,transient hypocalcaemia,permanent hypocalcaemia,operative time,number of removed lymph nodes,hospital stay and skin cosmetic.Moreover,TET had lower transient hypocalcemia(OR,1.66;P<0.05),smaller number of the retrieved lymph nodes(WMD,0.46;P <0.05),and better cosmetic satisfaction(WMD,1.73;P <0.05).However,COT was associated with shorter operation time(WMD,-50.28;P <0.05),lower the transient RLN palsy(OR,0.41;P<0.05).Conclusions: Firstly,the results show that in terms of safety and efficacy,TET was similar to COT for the treatment of thyroid cancer.Indeed,the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT.TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction,and thus is the better option for patients with cosmetic concerns.Second,the study provides strong evidence that TET is an equally safe and effective treatment for thyroid cancer as COT.TET is the preferred option for thyroid cancer patients with cosmetic needs.Overall,randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.