Treatment of differentiated thyroid cancer: can endoscopic thyroidectomy via a chest-breast approach achieve similar therapeutic effects as open surgery?
BACKGROUND
An analysis of some special factors was performed to further evaluate and discuss whether endoscopic surgery and traditional open surgery have similar therapeutic outcomes for differentiated thyroid cancer (DTC).


METHODS
A retrospective study was performed on 76 patients undergoing surgery to treat DTC. Forty patients were treated by endoscopic thyroidectomy via the chest-breast approach (endoscopic group) and thirty-six patients were treated by open surgery (open group). Serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the thyroid residual area (RITRA), radionuclide imaging of suspicious lymph nodes metastasis (RISLNM), and other general indexes were analyzed and compared between the two groups.


RESULTS
All surgeries were successfully completed in both groups. There were no significant differences between the two groups regarding gender (P = 0.120), postoperative hospital stay (P = 0.766), operation time (P = 0.065), intra-operative blood loss (P = 0.064), tumor diameter (P = 0.059), and overall complications (P = 0.828). Among these complications, there was no significant difference between the two approaches in transient hypoparathryoidism (P = 0.771), transient recurrent laryngeal injury (P = 0.474) and serious neck skin traction sensation (2.5 vs. 0%, P = 1.000). Age and body mass index were lower in the endoscopic group than the open group (P < 0.05). No significant difference was found in special factors between two groups concerning surgical range (P = 0.872), RAIU-2 h/24 h (P = 0.660/P = 0.955), RATU (P = 0.116), number of dissected lymph nodes (P = 0.157), sTg before radioiodine therapy (P = 0.188), sTg after radioiodine therapy (P = 0.159), RITRA at different time points (99mTc 15 min: P = 0.144; 131I 24 h: P = 0.243; 131I 72 h: P = 0.624) and RISLNM (none: P = 0.805; central: P = 0.744; lateral: P = 1.000; central + lateral: P = 0.958).


CONCLUSION
Endoscopic total thyroidectomy and central lymph nodes dissection via a chest-breast approach are safe and effective. Through the detection of the postoperative special factors, a well-trained surgeon can achieve similar therapeutic results for selected patients with DTC, compared with open surgery.
['Qu|Rui|R|', 'Li|Jinyi|J|', 'Yang|Jingge|J|', 'Sun|Peng|P|', 'Gong|Jian|J|', 'Wang|Cunchuan|C|']
D000328:Adult D004724:Endoscopy D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D037981:Neck Dissection D061646:Operative Time D010043:Outcome and Process Assessment, Health Care D011183:Postoperative Complications D011877:Radionuclide Imaging D012189:Retrospective Studies D013964:Thyroid Neoplasms D013965:Thyroidectomy
Thyroidectomy Chest-breast approach Endoscopic surgery Thyroglobulin Radionuclide imaging Differentiated thyroid carcinoma