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Abstract
Purpose
It is well known that papillary thyroid cancer (PTC) has a good prognosis and high incidence in young women. The objective of the study was to review our criteria to select surgical modality and surgical results and to confirm the feasibility of endoscopic thyroidectomy according to the preoperative risk stratification in the treatment of papillary thyroid cancer.
Methods
Between May 2009 and April 2012, 197 patients underwent either a conventional open or an endoscopic thyroidectomy with the preoperative consideration of risk group using clinical parameters of AMES system (patient age, size of tumor, extrathyroid extension, and presence of distant metastasis). A retrospective analysis of the pathologic data according to AMES system after surgery was also conducted. The endoscopic thyroidectomy was performed using the BABA (bilateral axillobreast approach) method.
Results
Based on the method of operation, the low-risk group patients (n=197) were divided into two groups: endoscopic group (n=78) and open group (n=119). Procedure time, postoperative complication rates, and length of hospital stay were tracked, albeit these were not significantly different between the two groups. From the pathologic findings, it was reported that there were no significant differences in tumor size, extrathyroid extension, and metastasis and also in the Off T4 – thyroglobulin level between the two groups.
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Table 1.
Clinical characteristics of the patients in the two groups
| Total | Endoscopic group (n=78) | Open group (n=119) | P-value |
|---|---|---|---|
| Age (year) | 39.9±1.2 (13∼61) | 43.4±1.0 (19∼72) | 0.80 |
| Sex ratio (F:M) | 78:0 | 90:29 | 0.00 |
| Height (cm) | 159.4±0.7 (144.8∼177.5) | 161.1±0.8 (14.2∼181.1) | 0.69 |
| Weight (kg) | 58.8±1.0 (41.0∼77.5) | 63.8±1.1 (42.∼108.7) | 0.15 |
| Type of operation | 0.00 | ||
| Unilateral lobectomy | 39 (50.0%) | 19 (16.0%) | |
| Total thyroidectomy | 39 (50.0%) | 100 (84.0%) | |
| Operating time (min) | 185.9±5.4 (101∼365) | 164.2±5.9 (70∼420) | 0.11 |
| Postop. hospital stay | 3.95±0.35 (1∼25) | 3.82±2.61 (2∼14) | 0.93 |
| Tumor size (cm) | 0.92±0.01 (0.1∼5.00) | 1.23±0.09 (0.3∼5.00) | 0.13 |
| Extrathyroidal extension | 11/78 (14.1%) | 34/119 (28.6%) | 0.17 |
| Retrieved CLN No* | 4 (0∼42) | 16 (0∼95) | 0.00 |
| Central LN (+) rate | 14 (18.0%) | 58 (48.7%) | 0.00 |
| Multiplicity | 14/78 (17.9%) | 33/119 (27.7%) | 0.16 |
| Thyroiditis | 9 (11.5%) | 22 (18.5%) | 0.19 |
Table 2.
Comparison of postoperative complication between the two groups
| Endoscopic group (n=78) | Open group (N=119) | P-value | |
|---|---|---|---|
| Transient hypocalcemia | 35 (44.9%) | 67 (56.3%) | 0.12 |
| Permanent hypocalcemia | 1 (1.2%) | 0 (0.00%) | 0.83 |
| Transient RLN† palsy | 3 (3.8%) | 4 (3.4%) | 0.83 |
| Permanent RLN† palsy | 0 (0.00%) | 0 (0.00%) | NA* |
| Bleeding | 2 (2.6%) | 4 (3.4%) | 0.47 |
| Chyle leakage | 0 (0.00%) | 5 (4.4%) | 0.07 |
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