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Nomogram for predicting difficult transoral and submental thyroidectomy: a retrospective model development and
Ling Zhan1, Bomin Guo1, Zixia Tao1
1Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Shanghai, China.
Surgical Endoscopy
|April 11, 2025
Summary
A new nomogram predicts difficult transoral and submental thyroidectomy (TOaST) using preoperative factors like age, sex, thyromental distance, ultrasound findings, and TPO-Ab levels. This tool aids in surgical preparation and training.
Area of Science:
- Endocrine Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Transoral and submental thyroidectomy (TOaST) is a minimally invasive technique for thyroid cancer.
- No established methods exist to predict TOaST surgical difficulty preoperatively.
- Predicting surgical difficulty is crucial for patient safety and resource allocation.
Purpose of the Study:
- To identify preoperative factors indicative of difficult transoral and submental thyroidectomy (TOaST).
- To develop and validate a predictive model (nomogram) for difficult TOaST.
- To improve preoperative planning and surgical training for TOaST.
Main Methods:
- Retrospective analysis of 255 differentiated thyroid cancer patients undergoing TOaST.
- Classification of TOaST into difficult or normal based on operative time, conversion, and injury.
- Multivariate logistic regression to identify risk factors; nomogram development and internal validation.
Main Results:
- Five independent predictors of difficult TOaST identified: younger age, male sex, short thyromental distance (<7 cm), diffuse ultrasound changes, and elevated TPO-Ab.
- The nomogram demonstrated high predictive accuracy (AUC 0.908 training, 0.888 validation).
- No significant difference in complication rates between difficult and normal TOaST groups.
Conclusions:
- A validated nomogram accurately predicts difficult TOaST using preoperative factors.
- This tool enhances preoperative assessment, patient consultation, and surgical training.
- The nomogram supports optimized preparation and resource management for TOaST procedures.
