Endoscopic thyroidectomy via anterior chest and breast for the treatment of papillary thyroid carcinoma / 中华普通外科杂志

ABSTRACT

Objective To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest and breast for the treatment of patients with papillary thyroid carcinoma ( PTC ).Methods Endoscopic thyroidectomy was performed in 85 PTC patients between March 2006 and March 2010. Diagnosis was based on intraoprative frozen section. There were 83 females and 2 males, age averaged at 36. 3 years. Sixty three of 85 cases were diagnosed preoperatively as thyroid carcinoma and US revealed ipsilateral cervical lymph node enlargement suspective of metastasis in 12 cases. Endoscopic thyroidectomy plus selective neck dissection was performed. Results This procedure was carried out successfully in 84patients. There were 51 cases of papillary thyroid microcarcinomas(<1. 0 cm) , 28 cases between 1. 0 cm and<2. 0 cm, and 5 cases with the diameter between 2. 0 cm and 3. 0 cm. Total thyroidectomy, ispilateral lebectomy and ispilateral lebectomy plus contralateral subtotal lobetomy were performed in 4, 6, 74 cases,respectively. Central compartment dissection was performed in all of the 84 cases and ipsilateral neck dissection was also performed in 12 cases that were suspected metastatic lateral neck lymph nodes. The mean operative time was (113. 3 ±46. 5) minutes. No significant blood loss occurred. The mean number of lymph nodes yield in the central compartment and lateral compartment were 6. 5 (range 2 to 14) and 19. 2 (range 9 to 26 ), respectively. Forty-four cases ( 44/84, 52. 4% ) had metastatic lymph nodes in central compartment, while 11 cases (11/12,91.1% ) in lateral compartment. Six patients (6/84,7.14%) had transient vocal cord palsy and recovered after 1-2 months. Postoperative transient hypocalcaemia occurred in 4 cases (4. 8% ) , and there were no other major complications. The average postoperative hospital stay was 3. 7 days (range 3 to 6). No evidence of residual or recurrent disease was found at follow-up. The cosmetic results of this procedure were excellent. Conclusions The anterior chest and breast approach of endoscopic thyroidectomy is feasible and safe and cosmetic worthwhile for selected cases of PTC.