YU Weiping 1 , SHI Rongliang 2 , LU Zhongwu 2 , WANG Yunjun 2 , HU Jiaqian 2 , SUN Guohua 2 , QU Ning 2 , LIU Wanlin 2 , MA Ben 2 , WANG Yulong 2 , WEI Wenjun 2 , XIANG Jun 2 , WANG Yu 2
  • 1. Department of Thyroid and Breast Surgery, Pudong Hospital Affiliated to Fudan University, Shanghai 201399, P. R. China;
  • 2. Department of Head and Neck Surgery, Cancer Hospital Affiliated to Fudan University, Shanghai 200032, P. R. China;
WANG Yu, Email: neck1130@hotmail.com
papillary thyroid carcinoma; lymph node metastasis; video-assisted lateral neck dissection; open thyroid surgery; safety
10.7507/1007-9424.202507132
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Objective To compare the differences of curative effect, cosmetic effect, and shoulder-neck function protection effect between video-assisted lateral neck dissection (VALND) and traditional open thyroid surgery(OTS) in the treatment of papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis. Methods Fifty patients with unilateral PTC accompanied by ipsilateral cervical lymph node metastasis who underwent sternal incision approach VALND at Fudan University Shanghai Cancer Center and Pudong Hospital Affiliated to Fudan University from January 2013 to December 2019 were collected. And 100 patients with unilateral PTC and ipsilateral cervical lymph node metastasis who underwent OTS during the same period were randomly selected at a ratio of 1:2 using the random number method. All patients underwent unilateral thyroid lobectomy (or total thyroid lobectomy) + isthmus resection + central area (Zone Ⅵ) and cervical lymph node dissection on the affected side (zones Ⅱ-Ⅴ). The therapeutic effects were compared between the two groups. Results Compare to OTS group, the operation time of VALND group was longer (218.3 min±86.6 min vs. 185.7 min±42.8 min, P=0.002), but the hospital stay was shortened (6.1±2.2 d vs. 7.3±1.6 d, P<0.001). In terms of surgical efficacy, there were no statistically significant differences between VALND group and OTS group in the number of lymph node dissections, the number of lymph node metastases, and the postoperative tumor recurrence rate (P>0.05). As for surgical safety, the two groups had similar rates of postoperative complications including recurrent laryngeal nerve injury, hypoparathyroidism, postoperative hematoma and infection(P>0.05). In terms of postoperative recovery, the scar color, vascular distribution, thickness, and softness, as well as in shoulder stiffness, tightness, pain, and numbness in VALND group were significantly lower than those in OTS group (P<0.05). Conclusions For PTC patients with lateral cervical lymph node metastasis, there is no significant difference in surgical efficacy and safety between VALND and OTS. However, VALND group shows obvious advantages in reducing the length of cervical incisions, improving cosmetic effects, and protecting cervical and shoulder functions. Therefore, VALND through the sternal notch approach has high promotion and application value in clinical practice.

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