Quantitative comparison of three thyroidectomy approaches in neck muscles, voice, and swallowing functions

Shi-Lin Li; Pei Du; Tian Lv; Dong-ning Lu; Cheng-ying Shao; Yi-ning Zhang; Ru He; Wen-Shun Liu; Jia-Feng Wang; Wei-Li Ren; Ju-yong Liang; Jia-Jie Xu; Ming-Hua Ge

Asian Journal of Surgery (Apr 2024)

Quantitative comparison of three thyroidectomy approaches in neck muscles, voice, and swallowing functions

Shi-Lin Li,
Pei Du,
Tian Lv,
Dong-ning Lu,
Cheng-ying Shao,
Yi-ning Zhang,
Ru He,
Wen-Shun Liu,
Jia-Feng Wang,
Wei-Li Ren,
Ju-yong Liang,
Jia-Jie Xu,
Ming-Hua Ge

Affiliations

Shi-Lin Li: Jinzhou Medical University, Jinzhou, Liaoning, 121001, China; Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
Pei Du: Otolaryngology & Head and Neck Center, Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
Tian Lv: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
Dong-ning Lu: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
Cheng-ying Shao: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
Yi-ning Zhang: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
Ru He: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
Wen-Shun Liu: Jinzhou Medical University, Jinzhou, Liaoning, 121001, China; Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
Jia-Feng Wang: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou, 551700, China
Wei-Li Ren: Department of Breast and Thyroid Surgery, Shaoxing Shangyu People's Hospital, ShaoxAing, 312300, Shaoxing, Zhejiang, China
Ju-yong Liang: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Corresponding author. Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China.
Jia-Jie Xu: Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Corresponding author. Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China.
Ming-Hua Ge: Jinzhou Medical University, Jinzhou, Liaoning, 121001, China; Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Corresponding author. Jinzhou Medical University, Jinzhou, Liaoning, 121001, China.

Journal volume & issue: Vol. 47, no. 4
pp. 1734 – 1739

Abstract

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Objective: This study compares endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and sternocleidomastoid leading-edge approach (SLEA) with conventional open thyroidectomy (COT) in hemithyroidectomy. The main focus is on the protection of neck muscles (sternocleidomastoid, omohyoid, sternothyroid) and the postoperative function of voice and swallowing yielded through these common approaches. Methods: A total of 302 patients who underwent hemithyroidectomy were enrolled and divided into three groups: ETGUA (n = 101), SLEA (n = 100), and COT (n = 101). Ultrasound was used to measure the thickness of bilateral neck muscles, including the sternocleidomastoid, omohyoid, and sternothyroid. The changes in thickness on the surgical side compared to the non-surgical side. Analyzed factors included muscle thickness changes, Swallowing Impairment Score (SIS), Voice Handicap Index (VHI), Scar Cosmesis Assessment and Rating (SCAR), Neck Injury Index (NII), surgery duration, drainage volume, hospitalization, and number of lymph nodes. Results: The clinical characteristics among the three groups were consistent except for differences in sex, age, and BMI. Metrics such as sternocleidomastoid muscle, NII, hypocalcemia, postoperative PTH, transient hoarseness, and number of lymph nodes showed no significant differences among the three groups. However, significant differences were found in the duration of surgery, drainage volume, hospitalization period omohyoid muscle, Sternohyoid muscle, VHI, SIS, and SCAR (all p < 0.001). Conclusion: In comparison to COT, ETGUA and SLEA demonstrate superiority in protecting neck muscles and preserving voice and swallowing function without compromising surgical safety or radicality.

Published in Asian Journal of Surgery

ISSN: 1015-9584 (Print)
Publisher: Elsevier
Country of publisher: Hong Kong
LCC subjects: Medicine: Surgery
Website: http://www.journals.elsevier.com/asian-journal-of-surgery/

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