ObjectiveTo explore the safety, effectiveness and minimally invasive cosmetic evaluation results of treatment for papillary thyroid carcinoma (PTC) by video-assisted lateral neck dissection (VALND) or open lateral neck dissection (OLND).MethodsThe clinical data of patients with PTC who received surgical treatment in the Affiliated Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed. The data of 94 cases in the VALND group (n=47) and the OLND group (n=47) were finally included in this study, and perioperative conditions and minimally invasive cosmetic evaluation results between the two groups were studied.ResultsThere were no statistical differences of lateral metastatic lymph node numbers, operative time, postoperative drainage volume, drainage tube removal time and postoperative hospitalization days between the two groups (P>0.05). The lateral retrieved lymph node numbers, intraoperative blood loss, the degree of cervical paresthesia and the degree of cosmetic satisfaction in the VALND group were significantly better than those in the OLND group (P<0.05). There was no significant difference of surgical complications between the two groups (P>0.05).ConclusionWithout sacrificing surgical safety and effectiveness, VALND has better cosmetic effect and less neck trauma than OLND, which is worthy of clinical application and promotion.
ObjectiveTo 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. MethodsFifty 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. ResultsCompare 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). ConclusionsFor 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.