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Surgical methods of total thyroidectomy for differentiated thyroid cancer: a systematic review and Bayesian network meta-analysis
Yuan, Yuquan1,2,3,4; Pan, Bin1,2,3,4; Tang, Enjie5; Mo, Hongbiao4; Zhu, Junping4; Yi, Ziying4; Lu, Dengwei1,2,3,4; Yin, Tingjie1,2,3,4; Sun, Yiceng4; Yin, Supeng4,6
2024
摘要Background:Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and postoperative experience of patients among common surgical methods.Methods:The PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2023. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome.Results:Thirty-two studies comprising 7042 patients were included. Robotic bilateral axillo-breast approach (RBABA) and robotic gasless transaxillary approach (RGAA) retrieved fewer lymph nodes (LNs) than open thyroidectomy (OT). RBABA showed a significantly lower permanent recurrent laryngeal nerve (RLN) palsy rate than OT. According to SUCRA values, endoscopic transoral approach (EOA) ranked the highest in retrieved LNs (0.84), the proportion of stimulated serum thyroglobulin less than 1.0 ng/ml (0.77), and the pain score (0.77). Endoscopic bilateral areola approach (EBAA) ranked the highest in the transient RLN palsy rate (0.72). The endoscopic gasless transaxillary approach (EGAA) ranked the highest in the transient hypoparathyroidism rate (0.78). RBABA ranked the highest in the rate of permanent RLN palsy (0.94) and hypoparathyroidism (0.77). OT ranked the highest in operative time (0.92).Conclusions:Each surgical method of total thyroidectomy has benefits and limitations. EOA performed the best in maintaining surgical integrality and reducing the pain score, while taking a long operative time. Generally, RBABA showed the best advantage in protecting parathyroid glands and RLN but with the longest operative time. OT had the best advantage in operative time. Therefore, OT and EOA are ideal methods for patients with a higher risk of central LN metastasis. RBABA and EOA may not be suitable for elderly patients or those with high anesthesia risk.
关键词differentiated thyroid cancer thyroidectomy meta-analysis systematic review
DOI10.1097/JS9.0000000000000819
发表期刊INTERNATIONAL JOURNAL OF SURGERY
ISSN1743-9191
卷号110期号:1页码:529-540
通讯作者Yin, Supeng(yinsupeng@163.com) ; Yang, Zeyu(yangzeyucgh@163.com) ; Zhang, Fan(zhangfancgh@163.com)
收录类别SCI
WOS记录号WOS:001144567700028
语种英语