[A comparative study of endoscopic and traditional open surgery in the treatment of papillary thyroid carcinoma]

Objective: To evaluate the feasibility, safety and efficacy of endoscopic thyroidectomy in the treatment of papillary thyroid carcinoma through clinical follow-up. Methods: Patients who underwent total thyroidectomy and had a final pathologic diagnosis of papillary thyroid carcinoma at Department of Thyroid Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine between February 2013 and April 2014 were enrolled in this study; those who had family history of thyroid cancer or a history of radiation of the neck area were excluded. There were 78 male and 228 female pantients, aging from 20 to 77 years with an age of (45.6±12.7) years. The patients were then divided into two groups: endoscopic surgery group (n=48) and traditional open surgery group (n=258). The clinical and pathological features and long-term follow-up data were collected and analyzed. The differences in surgical trauma, completeness, postoperative complications, and recurrence and metastasis risks between the two groups were compared by t test, rank-sum test, χ(2) test or Fisher exact test. Results: Compared to open surgery, endoscopic thyroidectomy had significant longer surgical time ((3.2±0.6) hours vs. (1.6±0.5) hours, t=17.904, P=0.000), two cases converted to open surgery because of tumor invasion of the recurrent laryngeal nerve, and one because of a false negative cell biology preopertively. The two groups showed no significant difference in surgical trauma which was measured by bleeding, white blood cell, C reactive protein, drainage, and et al. During follow up, the two groups had no significant difference in rate of Tg<1 μg/L (97.9% vs. 91.9%, P=0.220). Recurrent rate showed no significant difference (4.1% in endoscopic group vs. 3.1% in open group, P=0.665) between the two groups after follow-up of (40.8±4.7) months. Recurrent time were either not significantly different ((23.5±21.9) months vs. (20.0±14.6) months, P=0.785) between the two groups. Conclusion: Compared with conventional open thyroidecomy, endoscopic thyroidectomy has the same safety, surgical completeness and long-term therapeutic effect.