Objective: To evaluate the feasibility of endoscopic-assisted or endoscopic-assisted combined with thoracoscopic upper mediastinal lymph node dissection (UMLND) via transcervical approach for papillary thyroid carcinoma (PTC).
Methods: The clinical data of 11 PTC patients undergoing endoscopic UMLND in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from December 2015 to July 2018 were retrospectively analyzed. Of the patients, 5 cases were males and 6 cases were females with a mean age of (45±18) years. Total thyroidectomy, central neck dissection, and lateral neck dissection were performed by open or endoscopic-assisted approach. UMLND was performed by either transcervical endoscopic-assisted or endoscopic-assisted plus thoracoscopic approach.
Results: Of the 11 patients, operation was successfully completed under endoscopic assistance in 10 cases, and 1 patient was converted to open thoracotomy because of severe adhesion of the metastatic lymph nodes to the innominate vein and it was difficult to ensure a safe separation. The average operative time of endoscope-assisted UMLND was (58.7±12.1) min, and the average length of postoperative hospital stay was (9.5±9.6) d. The average number of lymph nodes obtained from UMLND was 8.4±3.3, with a mean number of metastatic lymph nodes of 3.5±2.6. There were no complications associated with UMLND. The mean follow-up time was (16±7.0) months, the average serum thyroglobulin concentration of the patients was (1.85±2.21) ng/mL, and no tumor residual or recurrence was noted in any of the patients.
Conclusion: Transcervical endoscopic-assisted or endoscopic-assisted plus thoracoscopic UMLND is a safe and reliable approach for the treatment of thyroid papillary carcinoma, with a thorough clearance and minimally invasive operation as well as cosmetic results. So, it has greater clinical application value.