Right Central Lymph Node Dissection in Thyroidectomy: Can Endoscopic Chest-Breast Approach Be Used?

Area of Science:

• Surgical Oncology
• Endocrinology
• Minimally Invasive Surgery

Background:

• Central lymph node dissection (CLND) is crucial for thyroid cancer staging and treatment.
• Minimally invasive endoscopic techniques are increasingly explored for thyroid surgery.
• The chest-breast approach offers an alternative aesthetic and surgical access route.

Purpose of the Study:

• To evaluate the feasibility and safety of right-sided CLND during endoscopic thyroidectomy using the chest-breast approach.
• To compare the outcomes of endoscopic thyroidectomy with CLND to the traditional open cervical approach.

Main Methods:

• Retrospective analysis of 68 patients undergoing endoscopic thyroidectomy with right CLND (chest-breast approach) and 31 patients undergoing open thyroidectomy with right CLND (low-neck collar approach).
• Comparison of intraoperative and postoperative data, including tumor size, lymph node metastasis, complication rates, and hospitalization.
• Surgical indications and contraindications were strictly controlled for patient selection.

Main Results:

• All surgeries were completed successfully without conversion to open surgery in either group.
• No significant differences were observed in tumor size, lymph node metastasis incidence, or number of dissected/metastatic nodes.
• Temporary hypoparathyroidism was noted in both groups, but permanent complications like nerve injury, leakage, or death were absent. One endoscopic case required secondary surgery for lateral lymph node metastasis.

Conclusions:

• Endoscopic thyroidectomy through the chest-breast approach with right CLND is a safe and feasible option for carefully selected thyroid cancer patients.
• This technique achieves oncologic outcomes comparable to the open cervical approach for central lymph node dissection.
• It aligns with the principles of radical tumor treatment while offering potential cosmetic benefits.