Number Of Central Nodes Research Articles

Robotic versus open surgery for thyroidectomy and modified radical neck dissection in patients with papillary thyroid carcinoma with clinical lateral neck node metastasis (cN1b): Effectiveness and safety, oncological outcomes and long-term quality of life.

e18069 Background: Open thyroidectomy (TT) with modified radical neck dissection (MRND) is used for papillary thyroid carcinoma (PTC) with clinical lateral neck node metastasis (cN1b). robotic surgery for TT with MRND is being carried out and some studies have confirmed its efficacy. However, such studies are limited by indicators and samples. The study aimed to compare robotic TT with MRND with open surgery in patients with cN1b PTC in efficacy, safety, oncological outcomes and quality of life. Methods: In this retrospective cohort study, 2027 patients receiving MRND between January 2016 and December 2021 were enrolled. After exclusion, 1153 PTC patients met the inclusion criteria, in which 168 (14.57%) underwent robotic surgery and 985 (85.43%) underwent open surgery. Propensity score matching (PSM) at a 1:2 ratio was performed to minimize bias. We compared the efficacy, safety and oncological outcomes before and after PSM, we also evaluated the quality of life of patients after PSM. Results: Before and after PSM, the number of central lymph nodes ( p<0.001) and lateral cervical lymph nodes(p<0.001),and the number of positive lateral cervical lymph nodes(before PSM p=0.037, after PSM, p=0.018 ) in the robotic group were lower than those open group. RAI-avid lesion in postoperative 131 RAI scan showed no difference between two groups and showed similar complication rates before or after PSM, including chyle leakage, infection, and permanent hypoparathyroidism. Because the rate of parathyroid misresection and the number of transplanted parathyroid glands were improved, robotic was superior to open group in preventing transient hypoparathyroidism. The patients were followed up for mean 50.57 months in the robotic group and 51.78 months in the open group. There was no difference between two groups in recurrence rate (before PSM: 5/168 [2.98%] vs 32/985 [3.25%], p>0.99; after PSM: 5/168 [2.98%] vs 15/336 [4.46%], p=0.572) and distant metastasis rate (before PSM: 1/168 [0.60%] vs 3/985 [0.30%], p>0.99; after PSM: 1/168 [0.60%] vs 1/336 [0.30%], p>0.99). We conducted a quality of life survey in 504 patients after PSM and collected 317 copies, of which 316 were valid. Compared with the open group, the robotic group had similar performance in health-related quality of life(HR-QOL) and the QOL issues specific to thyroid cancer, including subjective voice, dysphagia, neck and shoulder disability. The scores of scar showed a significant difference in the appearance and psychosocial impact of scars between two groups (p<0.001). Conclusions: Robotic surgery can provide more meticulous operation to reduce postoperative complications and better quality of life, especially scars, there is no significant difference in oncologic outcomes between two groups.

Risk factors associated with preferential lateral lymph node metastasis in papillary thyroid carcinoma.

Lateral lymph node metastasis (LLNM) is common in patients with papillary thyroid cancer (PTC), usually occurring after central lymph node metastasis (CLNM). However, some patients experience LLNM without first developing CLNM. This study aimed to identify the risk factors for developing LLNM without CLNM. We retrospectively reviewed 421 patients diagnosed with PTC who underwent lobectomy or total thyroidectomy with central and ipsilateral lateral lymph node dissection. We collected clinicopathological data and used univariate and multivariate logistic regression analyses to determine the risk factors associated with LLNM without CLNM. The LLNM without CLNM frequency was 18.3% (77/421). Univariate analyses demonstrated that age over 55 years, primary tumor in the upper portion of the thyroid, the number of central lymph node (CLN) and LLNM, primary tumor size, and the summed size of multi-foci tumors smaller than 1 cm were significantly associated with LLNM without CLNM (p < 0.05). Multivariate analysis revealed that LLNM without CLNM was more likely to occur in patients aged ≥55 years (odds ratio [OR], 2.309; 95% confidence interval [CI], 1.133-4.704; p = 0.021), and primary tumor in the upper portion of the thyroid (OR, 0.524; 95% CI, 0.295-0.934; p = 0.028). The lymph node metastasis pattern in patients with PTC is not constant. Therefore, surgeons should evaluate the lateral lymph nodes, especially in patients older than 55 years or when the primary tumor is in the upper portion of the thyroid.

Transoral endoscopic thyroidectomy vestibular approach vs. transoral robotic thyroidectomy: systematic review and meta-analysis.

This study aimed to conduct a systematic review and meta-analysis to compare the surgical outcomes of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT). We carried out a systematic literature search of PubMed, Web of Science, Cochrane Library, and Google Scholar on studies comparing TOETVA and TORT until January 2023. A total of five articles published between 2018 and 2023 that matched the inclusion criteria were included in the systematic review and meta-analysis. The studies included 641 patients (394 TOETVA patients and 247 TORT patients). TOETVA group was associated with a significantly shorter operative time with a mean difference of 60.08min [95% confidence interval (CI) -83.95 to -36.20; P < 0.001). Transient recurrent laryngeal nerve palsy was more common in the TOETVA group than the TORT group (OR 3.00; 95% CI 1.14-7.88; P = 0.03). There were no significant differences in the other outcomes, including the length of hospital stay, postoperative pain scores, number of central lymph nodes retrieved, permanent recurrent laryngeal nerve injuries, and transient and permanent hypoparathyroidism. The TOETVA group was associated with shorter operative time and more transient recurrent laryngeal nerve palsy than the TORT group. Each procedure has its benefits and limitations. The surgical approach should be determined by considering the patient's characteristics and preferences, as well as the surgeon's preference and area of expertise.

Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Gasless Transaxillary Endoscopic Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and gasless transaxillary endoscopic thyroidectomy (GTET) are 2 newly applied technologies. This study is to compare the 2 approaches from the aspects of effectiveness and safety. A total of 339 patients who underwent TOETVA or GTET with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2022. The 2 groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative outcomes. The operative time of the TOETVA group was significantly longer than the GTET group (141.39±16.11 vs. 98.45±12.24, P<0.05). The TOETVA group had advantages over GTET group when the reduction of parathyroid hormone was compared (19.18±17.43 vs. 23.07±15.72, P<0.05). Meanwhile, more parathyroids were detected in central neck specimens in GTET group (40/181 vs. 21/158, P<0.05). TOETVA had an advantage on total number of central lymph nodes over GTET (7.65±3.11 vs. 4.99±2.45, P<0.05), whereas the number of positive central lymph nodes was similar (P>0.05). No differences were found between the 2 groups on other data. TOETVA and GTET are both safe and effective for unilateral papillary thyroid carcinomas. TOETVA has advantage on protection of inferior parathyroid glands and harvest of central lymph node dissection. Meanwhile, GTET can save more time compared with TOETVA. Surgeons and patients should freely choose the approaches based on their demands.

Transoral endoscopic thyroidectomy vestibular approach as a safe and feasible alternative to open thyroidectomy: a systematic review and meta-analysis.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless alternative to open thyroidectomy (OT). This systematic review and meta-analysis aimed to synthesize evidence comparing the intraoperative and postoperative outcomes of TOETVA and OT. A systematic literature search of PubMed, Web of Science, the Cochrane Library, and Google Scholar was performed to identify studies comparing the outcomes of TOETVA and OT published before February 2023. The outcomes of interest were operative time, intraoperative blood loss, hospital stay, postoperative pain, number of central lymph nodes retrieved, number of metastatic central lymph nodes, and incidences of transient and permanent recurrent laryngeal nerve injury, transient and permanent hypocalcemia, hematoma, and infection. Thirteen studies published between 2016 and 2022, involving a total of 2889 patients (TOETVA, n =1085; OT, n =1804) were included in this systematic review and meta-analysis. Meta-analysis showed that the TOETVA group had a significantly longer overall operative time (weighted mean difference [WMD] 55.19; 95% CI, 39.15, 71.23; P <0.001), longer hospital stay (WMD, 0.27; 95% CI, 0.14, 0.39; P <0.001), and lower pain scores on postoperative day 1 (WMD, -1.41; 95% CI, -2.79, -0.03; P =0.04) than the OT group. Other intraoperative and postoperative outcomes were not significantly different between the groups. TOETVA has a similar safety profile to OT with less postoperative pain, making it an appropriate and more cosmetically appealing alternative to OT for select patients.

Robotic bilateral axillo-breast versus endoscopic bilateral areola thyroidectomy outcomes of 757 patients.

Remote endoscopic thyroidectomy (ET) and robotic thyroidectomy (RT) seem to be beneficial in selected situations to avoid anterior neck scars. There are limited data in the literature to determine whether RT via a bilateral axillo-breast approach (RT-BABA) is superior to ET via a bilateral areolar approach (ET-BAA). Therefore, the aim of this study was to evaluate the surgical outcomes of RT-BABA versus ET-BAA. Between May 2013 and May 2022, 757 patients who underwent RT-BABA or ET-BAA at a high-volume Chinese thyroid center were included. Intraoperative and postoperative outcome parameters were collected and retrospectively analyzed. The moving average method was used to evaluate the learning curve. The proportion of patients older than 45 years was greater in the RT group than in the ET group (14.8% vs. 7.4%, p < 0.001). The percentage of overweight patients was greater in the RT group (28.8% vs. 9.5%, p < 0.001). The number of patients treated for malignant lesions was higher in the RT group (86.8% vs. 75%, p < 0.001). The rate of thyroiditis was higher in the RT group (10.9% vs. 6.6%, p < 0.001). Surgical time was significantly shorter in the RT group (140 vs. 165min, p < 0.001). Drainage volume was higher in the RT group (100 vs. 85ml, p < 0.001). Postoperative hospital stay was shorter in the RT group (3.04 ± 0.44 vs. 3.67 ± 0.89 days, p < 0.001). The cost in the RT group was higher (49627 ± 2795 vs. 25094 ± 3368 yuan, p < 0.001). Transient vocal cord dysfunction was lower in the RT group (2.9% vs. 8.0%, p = 0.003). There was no significant difference between the two groups in the number of central lymph nodes sampled, positive lymph nodes, neural monitoring (EMG) results, and rate of transient hypoparathyroidism. The learning curve for RT was 26 cases, and the operative time for ET was constant throughout the study. RT-BABA is as safe and feasible as ET-BAA. RT-BABA performed better in some surgical outcomes. Further prospective studies are needed to confirm the safety of RT-BABA.

Dynamic Pathway Selection Mechanisms of Brain Networks

Based on the dynamic reorganization mechanism of brain science and the fact that synaptic adaptability is affected by synaptic type, synaptic number and ion concentration, a bionic dynamic synaptic model is proposed and applied to a motif model and brain-like network model. By extracting the phase synchronization characteristics of the neural signals of node pairs in time sequence, and then deeply studying the regulation and control effect of synchronous discharge activities on effective links under the action of stimulating information, the path selection strategy is designed with the goal of maximizing the information transmission capacity between nodes. Four indicators are proposed: (1) pathway-synchronization-facilitation; (2) pathway-activation; (3) pathway-phase-selectivity; (4) pathway-switching-selectivity, which are used as the main basis for path selection in the network. The results show that the in-phase and anti-phase transition of neuron nodes under the action of time delay is an important way to form an effective link, and, in addition to the influence of synaptic strength and the number of central nodes on synchronization characteristics, the phase information carried by the stimulus signal also regulates the path selection. Furthermore, the paths between the pairs of stimulus nodes in the network have different phase preferences. In the brain-like network with twenty nodes, it is found that nearly 42% of the stimulus nodes have a strong phase preference; that is, the path can be selected and switched through the phase information carried by the information flow, and then the path with better representation information can be found. It also provides a new idea for how brain-like intelligences might better represent information.

A retrospective study of papillary thyroid carcinoma: Hashimoto's thyroiditis as a protective biomarker for lymph node metastasis

PurposeThere is approximately 10%–50% of papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT). In this research, we sought to better understand the role of HT in PTC progression as well as lymph node metastasis. MethodsIt is a retrospective and cross-sectional study, and 4131 PTC patients who underwent thyroidectomy were finally enrolled. Chi-square test, univariate and multivariate logistic regression analyses were employed to evaluate both the risk factors and the critical roles of HT during PTC metastasis. ResultIn this cohort, 1555 patients (37.6%) were diagnosed with HT. According to multivariate analysis, male sex, high levels of TG and TPOAb, tumor extrathyroidal extension, maximum diameter >1 cm, and multifocality were independent risk factors for both central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). In addition, age <55 years and smoking were risk factors for CLNM, while CLNM was one of the risk factors for LLNM. Furthermore, HT was suggested a valuable protective factor for both CLNM and LLNM. In patients with HT, the total number of central lymph nodes was higher, while the positive rate was lower. Compared with those without HT, age and sex did not predict CLNM and LLNM in patients with HT. ConclusionHT is considered a protective factor for both CLNM and LLNM in PTC. For patients with HT, surgeons should pay more attention to the preservation of parathyroid gland and the protection of recurrent laryngeal nerve due to less lymph node metastasis. Otherwise, radical operation is highly recommended.

Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

PurposeThis study aimed to examine the effect of selective inferior parathyroid gland autotransplantation on central lymph node dissection(CLND) and incidence of postoperative hypoparathyroidism in patients undergoing endoscopic radical resection of thyroid carcinoma.MethodsThe data of 310 patients undergoing endoscopic radical resection of thyroid carcinoma will be retrospectively analyzed. The patients will be divided into the experimental group and the control group according to whether they combined with parathyroid autotransplantation. Statistics of the incidence rate of postoperative hypoparathyroidism, the concentration of PTH and Calcium in the systemic circulation at different time points in the two groups, the concentration of PTH in the cubital fossa vein in the transplantation region in the experimental group, and the number of central lymph nodes and positive lymph nodes dissection will be carried out.ResultsThe incidence rate of temporary and permanent hypoparathyroidism in the experimental group was 33.75% and 0.625%, respectively, and in the control group was 22% and 5%, respectively; its difference was statistically significant (X2 = 10.255, P=0.006). Parathyroid autotransplantation increased incidence of transient hypoparathyroidism (OR, 1.806; Cl, 1.088-2.998; P=0.022), and lower incidence of permanent hypoparathyroidism (OR, 0.112; Cl, 0.014-0.904; P=0.040). The diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism (OR, 0.769; Cl, 0.467-1.265; P=0.301) or permanent hypoparathyroidism (OR, 1.434; Cl, 0.316-6.515; P=0.641). Comparison of systemic circulation PTH, between the two groups showed that the PTH of patients in the experimental group was higher than that in the control group from 1 week to 12 months after the operation, and the difference was statistically significant (P<0.05). In the experimental group, from 1 week to 12 months after surgery, PTH concentrations was significantly higher in the cubital fossa of the transplantation side than in the contralateral side, and the differences were statistically significant (P<0.05). The mean number of central lymph node dissected per patient was significantly higher in the experimental group (7.94 ± 3.03 vs. 6.99 ± 2.86; P <0.05); The mean number of positive nodes per patient was significantly higher in the experimental group (3.16 ± 1.86 vs. 2.53 ± 1.59; P <0.05).ConclusionsIn endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is more beneficial to postoperative parathyroid glands function recovery, effectively preventing postoperative permanent hypoparathyroidism and realizing more thorough CLND.

Effectiveness of transoral endoscopic thyroid surgery for lymph node dissection in the central region of thyroid cancer

Objective:To investigate the effect of transoral endoscopic thyroid surgery in the central lymph node dissection of thyroid cancer. Methods:Twenty patients underwent endoscopic thyroidectomy via oral vestibular approach （TOETVA group） and 20 gender and age matched patients underwent conventional open thyroidectomy were selected in this study. The clinical data, number of lymph node dissection and postoperative complications of the two groups were collected and analyzed. SPSS 24.0 statistical software was used for data analysis. Results:There was no significant differences in age, BMI, tumor size or the number of Hashimoto's thyroiditis patients between the TOETVA group and the open group（P>0.05）. The operation time（[117.30±10.54]min） and postoperative drainage volume（[146.05±30.66]mL） in the TOETVA group were significantly higher than those in the open group（[59.05±6.40]min, [77.90±22.18]mL）, P<0.001. The pain in the open group 24 h after surgery was more severe than that in the TOETVA group（P<0.05）. The total number of central lymph nodes, the number of pre-laryngeal lymph nodes and the number of pre-tracheal lymph nodes cleared by the two groups were similar, and the number of final positive lymph nodes had no significant difference. However, the number of paratracheal lymph nodes removed in the TOETVA group was more（7.8±4.2） nodes than that in the open group（6.4±3.9） nodes, P<0.05. There was no significant difference in postoperative complications between the two groups. The scores of cosmetic evaluation and rating of cicatrices in the TOETVA group six months after surgery were（0.77±0.58） significantly lower than those in the open group（4.30±1.54）, P<0.001. Conclusion:In central lymph node dissection, the efficiency of TOETVA is similar to that of traditional open thyroid surgery. For special anatomical regions, endoscopic surgery is more efficient. At the same time, TOETVA does not increase the incidence of related complications, and has good cosmetic effect.

A comparative study of two robotic thyroidectomy procedures: transoral vestibular versus bilateral axillary-breast approach

ObjectiveTo compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomy (BABART).MethodsA total of 99 patients with papillary thyroid carcinoma but no distant metastasis were enrolled in this study from May 2020 to April 2021. Lobectomy or total thyroidectomy with central lymph node dissection were performed in all cases. All 99 patients were received an ultrasound guided fine needle aspiration biopsy prior to surgical intervention, out of which 49 patients underwent TOVRT, while rest 50 patients underwent BABART. During the procedure, intraoperative neuromonitoring system was used and all recurrent laryngeal nerves (RLNs) were preserved, additionally for TOVRT procedure, three intraoral ports or right axillary fold incision was used to allow for fine countertraction of tissue for radical oncological dissection. The clinical data including age, gender, height, weight, BMI, primary tumor size, number of central lymph node removed, central lymph node metastasis, operating time, total hospital stays, postoperative hospital stays, total postoperative drainage volume, postoperative pain score, cosmetic effect and complications were recorded and analyzed.ResultsThere were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups (P > 0.05). Patients accepted TOVRT were younger and had smaller primary tumor size than those who accepted BABART. The TOVRT group had a longer surgical time than the BABART group, but with smaller postoperative drainage volume and superior cosmetic effect (under visual analogue scale, VAS) (P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (under numerical rating scale, NRS) between the two groups (P > 0.05). Last but not least, certain peculiar complications were observed in TOVRT group: paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case).ConclusionTransoral-vestibular robotic thyroidectomy is safe and feasible for certain patients, which could be considered an alternative approach for patients who require no scarring on their neck.

Carbon Nanoparticles for Thyroidectomy and Central Lymph Node Dissection for Thyroid Cancer.

To evaluate whether the application of carbon nanoparticles (CNs) in total or near-total thyroidectomy combined with central lymph node dissection (CLND) for thyroid cancer (TC) is beneficial to lymph node dissection, parathyroid, and recurrent laryngeal nerve (RLN) protection. Relevant literatures were systematically searched on PubMed, EMBASE, and Cochrane Library Databases until March 31, 2021. All analyses were performed using Revman Manager 5.3 software. The main results were the number of central lymph nodes, the number of central metastatic lymph nodes, accidental parathyroidectomy, postoperative hypoparathyroidism, postoperative hypocalcemia, and postoperative transient RLN paralysis. This meta-analysis identified 4 randomized controlled trials and 8 non-randomized controlled trials comprising 1870 patients. Compared with the control, the use of CNs was helpful to dissect more central lymph nodes (weighted mean difference [WMD]: 3.55, 95% confidence interval [CI]: 2.12-4.98, P < .00001) and central metastatic lymph nodes (WMD: 1.69, 95% CI:1.31-2.08, P < .00001), lower rate of accidental parathyroidectomy (odds ratio [OR]: .33, 95% CI: .23-.47, P < .00001), lower rate of both postoperative transient hypoparathyroidism (OR: .40, 95% CI: .31-.51, P < .00001), and transient hypocalcemia (OR: .37, 95% CI: .27-.51, P < .00001). However, there were no statistical difference between the groups for postoperative permanent hypoparathyroidism (OR: .29, 95% CI: .06-1.28, P = .10), postoperative permanent hypocalcemia (OR: .94, 95% CI: .10-9.16, P = .96), and postoperative transient RLN paralysis (OR: .66, 95% CI: .40-1.12, P = .12). The application of CNs in total or near-total thyroidectomy combined with CLND for TC can better dissect the central lymph nodes and protect parathyroid glands (PGs) and their function.

Comparison Between Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) and Conventional Open Thyroidectomy for Patients Undergoing Total Thyroidectomy and Central Neck Dissection: A Propensity Score-Matching Analysis.

BackgroundUse of the novel transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasing worldwide. Although several studies have compared safety and efficacy of TOETVA and other approaches, most focused on comparisons in the context of unilateral thyroidectomy. Therefore, the present study aimed to compare the safety and surgical completeness of TOETVA with conventional open thyroidectomy (COT) in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy and central neck dissection.MethodsThe medical records of patients who underwent TOETVA or COT by a single surgeon between June 2017 and October 2021 were retrospectively reviewed. All patients were diagnosed with PTC and underwent total thyroidectomy with central neck dissection. Propensity score-matching (PSM) was used to reduce potential selection bias and to adjust for differences in baseline clinicopathological characteristics.ResultsAfter PSM, 84 (TOETVA: 28; COT: 56) patients remained in the study population. There were no significant differences in sex, mean age, combined thyroiditis, tumor size, capsule invasion, tumor multifocality in the same lobe, or tumor location between the groups. Operative time was longer (190.54 ± 28.26 vs. 123.93 ± 29.78 min, P<0.001), while postoperative drainage volume (161.07 ± 225.30 vs. 71.16 ± 28.56 ml, P=0.045) was greater, in the TOETVA group than in the COT group. The groups exhibited no significant differences in the mean number of central lymph nodes retrieved (9.39 ± 4.01 vs. 10.71 ± 5.17, P=0.202), mean number of metastatic central lymph nodes (1.36 ± 1.93 vs. 1.77 ± 2.31, P=0.421), postoperative mean thyroglobulin levels (0.08 ± 0.24 vs. 0.10 ± 0.27, P=0.686), rate of transient hypoparathyroidism (TOETVA: 67.9% vs. COT: 66.1%, P=0.870), rate of transient vocal cord palsy (TOETVA: 0% vs. COT: 1.8%, P=1.000), or other complications (TOETVA: 3.6% vs. COT: 0%, P=0.333).ConclusionsTOETVA is a safe approach in select patients with PTC and exhibits similar efficacy to COT in terms of surgical completeness.

Endoscopic thyroidectomy using gasless axillary approach for low-risk papillary thyroid carcinoma.

To evaluate the application of endoscopic thyroidectomy using gasless axillary approach (ET-GA) for low-risk papillary thyroid carcinoma (PTC). Patients with T1N0M0 Ⅰ PTC undergoing unilateral thyroid lobectomy with central neck dissection in Taizhou Cancer Hospital during January 2019 to June 2021 were enrolled in the study, including 35 cases treated with ET-GA (ET-GA group) and 35 cases treated with conventional open thyroidectomy (COT group). The surgical treatment effect, cosmetic effect and the effect on neck function were compared between two groups. Neck function was evaluated by neck pain score, neck injury index and dysphagia index. Cosmetic effect was evaluated by cosmetic effect satisfaction score. In the ET-GA group, all unilateral thyroid lobectomy with central neck dissection were successfully completed, and no case was converted to open surgery. The number of central lymph nodes dissected in the ET-GA was not statistically different from that in the COT group (>0.05), but the operation time was longer than that of the COT group (<0.01). In the ET-GA group, 2 cases (5.7%) had transient vocal cord paralysis and 1 case (2.9%) had postoperative bleeding. In the COT group, 1 case (2.9%) had transient vocal cord paralysis, no postoperative bleeding. There was no significant difference in the complication rate between two groups (>0.05). At and postoperatively, there was no significant difference in neck pain score and neck injury index between two groups (both >0.05); dysphagia index was lower in ET-GA group, but the difference was not statistically significant (>0.05). The cosmetic effect satisfaction score of ET-GA group was higher than that in the COT group at postoperatively (4.3±0.6 vs.1.0, <0.01). ET-GA has the same efficacy and safety as conventional open thyroidectomy in the treatment of low-risk PTC, and it improves the satisfaction of postoperative cosmetics.

ASEAN logistics network model and algorithm

Reasonable layout of logistics centers in the ASEAN countries has important practical significance for improving logistics network efficiency and reducing logistics transportation costs. This paper based on the current status of the ASEAN logistics network and the characteristics of the hub-and-spoke network, taking the minimum total cost as the optimization goal, establishing the central location model, and the design self-adaptive genetic algorithms to solve it. Therefore, the number of central nodes in the ASEAN logistics network has been determined, the radiation range between nodes, and route allocation. The results indicate that the ASEAN network layout model is a hub-and-spoke logistics network. With Singapore as the logistic center hub node. Jakarta logistics development belt will form the main radiating logistics demand cities of Kuching and Ho Chi Minh city. Kuala Lumpur logistics development belt’s main radiating logistics demand cities will be East Kalimantan and Da Nang city. Chon Buri logistics development belt mainly radiates the cities of Phnom Penh and Riau city. Bangkok logistics development belt mainly radiates the cities of Hanoi, Vientiane, and Yangon city.

Risk factors for central lymph node metastasis in the cervical region in papillary thyroid carcinoma: a retrospective study

BackgroundTo investigate the influence of different risk factors on central lymph node metastasis (CLNM) in the cervical region in patients with papillary thyroid carcinoma (PTC).MethodsThis retrospective study included 2586 PTC patients. Potential risk factors were identified by univariate analysis, and the relationships between these factors and CLNM were ascertained by multivariable analysis. A scoring system was constructed, and the optimal cut-off value was determined.ResultsOn univariate analysis, sex, age, tumor diameter, multifocality, capsule invasion, vascular invasion, total number of lymph nodes in the central region, and serum thyroid peroxidase antibody (TPOAb) concentration were identified as potential risk factors for CLNM in the cervical region, whereas nerve invasion, thyroid-stimulating hormone concentration, and thyroglobulin antibody (TgAb) concentration were not. Multivariable analysis indicated that male sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were significant risk factors. From these factors, a preoperative CLNM risk assessment scale was constructed for predicting CLNM in the cervical region for PTC patients.ConclusionMale sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were positively correlated with CLNM in the cervical region in PTC patients. The preoperative CLNM risk assessment scale based on these risk factors is expected to offer accurate preoperative assessment of central lymph node status in PTC patients.

Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Endoscopic Thyroidectomy Via Areola Approach for Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study.

Endoscopic thyroidectomy via areola approach (ETA) has been widely used in thyroidectomy for many years as it can effectively avoid a scar in the neck. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is newly applied and has gained popularity quickly. This study is to compare the safety and effectiveness of TOETVA and ETA. A total of 95 patients who underwent TOETVA or ETA with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2020. The basic information (such as gender, age), intraoperative hemorrhage, postoperative drainage volume, hospital durations, intraoperative and postoperative complications, operative time, central lymph node dissection time, total number of central lymph nodes, and number of metastatic central lymph nodes were compared. The operative time of the TOETVA group was significantly longer than the ETA group (148.11±19.78 vs. 135.90±12.77 min, P<0.05). However, the result was opposite when central lymph node dissection time was compared (10.31±2.93 vs. 12.48±3.55, P<0.05). TOETVA had an advantage on total number of central lymph nodes over ETA (7.82±3.35 vs. 5.26±2.45, P<0.05). No differences were found between the 2 groups on other data. TOETVA and ETA have the similarity on surgical safety and effectiveness. TOETVA has its advantage on central lymph node dissection and might be a reasonable alternative for ETA and open surgery in the future.

Predictive factors of lateral lymph node metastasis in conventional papillary thyroid carcinoma.

Lymph node metastasis (LNM) has been a significant predictor for local recurrence and distant metastasis in papillary thyroid carcinoma (PTC). However, the clinical predictors for conventional papillary thyroid carcinoma (CPTC) with lateral lymph node metastasis (LLNM) have yet to be established. Our work aimed to effectively identify the risk factors of LLNM in CPTC, helping surgeons to devise better individualized therapy strategies. We retrospectively analyzed 652 patients who were diagnosed with CPTC in the Department of General Surgery at Guangdong Provincial People's Hospital between October 2015 and June 2019. Univariate and multivariate logistic regression was used to analyze the correlation between clinicopathological characteristics and the LLNM of CPTC. The incidence of LLNM in CPTC was 29.75% (194 of 652 patients). Univariate analysis found that LLNM was significantly associated with gender, age, number of central lymph nodes (CLNs), primary tumor location, multifocality, maximum tumor diameter, and BRAF V600E mutation. Independent risk factors for LLNM were multifocality (P=0.017, OR =4.325, 95% CI: 1.298-14.408), maximum tumor diameter (P<0.001, OR =4.076, 95% CI: 1.945-8.540), primary tumor location (P=0.037, OR =2.127, 95% CI: 1.046-4.328), number of CLNs (P<0.001, OR =8.604, 95% CI: 3.630-20.390), and BRAF V600E mutation (P=0.001, OR =3.913, 95% CI: 1.803-8.496) by multivariate analysis. LLNM in CPTC was related to the large volume of central lymph node metastasis (CLNM), tumor located in the upper lobe, multifocality, tumor diameter >2 cm, and BRAF V600E mutation-negative, which should be considered when examining patients with suspected metastasis in the lateral compartment.

Analysis of the factors for the lymph node metastasis in rⅥb region of thyroid micropapillary carcinoma and the application value of intraoperative nano-carbon

Objective:To investigate the relationship between lymph node metastasis in rⅥb region and pathological features of papillary thyroid microcarcinoma, and the application value of carbon nanoparticles in the operation for lymph node dissection in rⅥb region. Method:One hundred and seventy-five patients were divided into carbon nanoparticles group and the control group depending on whether carbon nanoparticles were used in the operation. The operation time, the number of central lymph node, the number of rⅥb region lymph node, hypocalcaemia symptom complex and hoarseness after the operaion were compared between the two groups. The lymph node metastasis in the rⅥb region and the pathological features of papillary thyroid microcarcinoma were statistically analyzed. Result:The amount of lymph nodes in Central District and rⅥb region was increased and the probability of parathyroid gland injury was decreased by using nano-carbon. The positive rate of lymph nodes in rⅥb region was not related to age, sex, aspect ratio of nodules and microcalcification, but was related to the tumor size, multifoci and the invasion of the capsule. The evaluation model of lymph node metastasis in rⅥb region was established based on the above three correlative features of color doppler ultrasound. The ROC curve analysis showed that the model had high application value . Conclusion:The tumor size, multiple foci and capsule invasion are risk factors for lymph node metastasis in rⅥb region of thyroid micropapillary carcinoma.

Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and total endoscopic thyroidectomy via areola approach (ETA) are commonly used endoscopic thyroidectomy approaches. This study compares the effectiveness of these approaches with conventional open thyroidectomy (COT) in terms of safety, associated trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma (PTC). This retrospective study included patients who underwent TOETVA (n = 100), ETA (n = 119), and COT (n = 289). All patients had a pathological diagnosis of PTC and underwent unilateral lobectomy and central neck dissection. We analyzed operative time, postoperative drainage volume, postoperative C-reactive protein (CRP), preoperative and postoperative white blood cell (WBC) count and parathyroid hormone (PTH) levels, parathyroid damage, hoarseness, total number of central lymph nodes, and number of metastatic central lymph nodes. The clinical characteristics across the three groups were similar except for patient sex and age. There was a higher proportion of young women in the TOETVA and ETA groups than in the COT group. There were significant differences between the three groups regarding operative time (P = 0.000), postoperative drainage volume (P = 0.000), postoperative CRP (P = 0.000), ∆WBC (P = 0.000), and length of postoperative hospital stay (P = 0.021); in the TOETVA and ETA groups, operative time (P = 0.445), postoperative drainage volume (P = 0.677), and length of postoperative hospital stay (P = 0.145) were not significantly different. The percentage of cases with parathyroid gland damage (P = 0.459) and hoarseness (P > 0.05) was similar in all groups. All three procedures were efficient in performing a central lymph node dissection. Although considered more traumatic, TOETVA and ETA are both safe treatment options for PTC. They can both achieve similar therapeutic effects of central neck dissection in the treatment of PTC when compared with open surgery.