Implantation of cancer cells from transoral endoscopic thyroidectomy: a case report

With the development and new technological knowledge, such as surgical techniques that accompany the consolidated open surgical procedures, minimally invasive strategies have also emerged for thyroid surgery. Among these, we can cite the transoral endoscopic vestibular approach known as TOETVA. Recurrences and metastases of differentiated thyroid cancer frequently manifest in the lymph nodes, lungs, bones, and liver. Although the primary implantation of cancer cells causing these recurrences and metastases is considered an uncommon event, it can nonetheless occur in specific instances. This can be a serious complication for patients, as these recurrences and metastases can be difficult to detect and treat effectively. Early identification and appropriate management of these cases are crucial for improving patient outcomes.

We present a case of a 55-year-old male patient with recurring muscular and subcutaneous recurrence that developed five years after the initial left thyroidectomy performed via a TOETVA. The patient therefore required a second surgical procedure of completion thyroidectomy, central lymph node dissection (level 6 and 7), and removal of nodes in subcutaneous tissue and muscle.

Tumor biology, local environment, technical issues, surgical skills, and the correct management and handling of neoplastic nodules represent crucial clinical pitfalls and important factors that can contribute to local recurrence and malignant cellular implantation following a TOETVA for thyroid surgery.