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Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis

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Abstract

Background

Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC).

Method

Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis.

Results

The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD − 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05).

Conclusions

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. 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.

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Funding

Supported by Gansu Province Science & Technology support program of Science and Technology department of Gansu Province (Grant No. 144FKCA073). Supported by Key Laboratory of Evidence Based Medicine and Knowledge Translation Foundation of Gansu Province(Grant No. GSXZYZH2018006). Supported by Foundation of Lanzhou Science and Technology Bureau (Grant No. 2017-ZD-38). Supported by Research Projects of Affiliated hospital of gansu university of traditional Chinese medicine (Grant No. gzfy-2017-09)

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Author notes

  1. Wen-Jie Jiang and Pei-Jing Yan are Co-first authors.

Authors and Affiliations

  1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People’s Republic of China

    Wen-Jie Jiang, Mou-Bo Si, Shuang-Wu Feng, Ke-Hu Yang & Tian-Kang Guo

  2. Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People’s Republic of China

    Mou-Bo Si, Hong-Wei Tian, Cai-Wen Han, Jia Yang & Tian-Kang Guo

  3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People’s Republic of China

    Ke-Hu Yang

  4. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People’s Republic of China

    Wen-Jie Jiang, Pei-Jing Yan, Mou-Bo Si, Cai-Wen Han, Jia Yang, Ke-Hu Yang & Tian-Kang Guo

  5. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, People’s Republic of China

    Ke-Hu Yang

  6. Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, People’s Republic of China

    Wen-Jie Jiang & Chun-Lin Zhao

  7. Department of General Surgery, First Clinical Center, PLA General Hospital, Beijing, 100000, People’s Republic of China

    Wen Tian & Yan-Jun Zhang

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Wen-Jie Jiang, Pei-Jing Yan, Chun-Lin Zhao, Mou-Bo Si, Wen Tian, Yan-Jun Zhang, Hong-Wei Tian, Shuang-Wu Feng, Cai-Wen Han, Jia Yang, Tian-Kang Guo and Ke-Hu Yang have declared that they have no conficts of interest or financial ties to disclose.

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Jiang, WJ., Yan, PJ., Zhao, CL. et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc 34, 1891–1903 (2020). https://doi.org/10.1007/s00464-019-07283-y

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