Yichao Zhang1, Zhiyong Dong2, Jinyi Li3, Jingge Yang4, Wah Yang5, Cunchuan Wang6. 1. Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: jnu_zyc1989@163.com. 2. Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: zhiyongdong1986@163.com. 3. Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: lijinyi2016@126.com. 4. Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: yangjg@yeah.net. 5. Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: yangwahh@163.com. 6. Department of Surgery, Jinan University Institute for Minimally Invasive Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: twcc@jnu.edu.cn.
Abstract
BACKGROUND: Despite experience with the use of endoscopic surgical technology, there is controversy over the role of endoscopic thyroidectomy (ET) for Graves' disease (GD). This study aimed to conduct a meta-analysis to evaluate the cosmetic and safety outcomes of ET versus conventional open thyroidectomy (OT) for GD with respect to short-term consequences. METHODS: We searched the following English language databases (Ovid MEDLINE, ISI Web of Science, and the Cochrane Library), and Chinese language databases (CNKI, CBMdisc, and SinoMed) between January 1996 and November 2015. The quality of the included studies was determined by the Newcastle-Ottawa Scale. A meta-analysis was conducted using RevMan 5.3 software. Pooled mean differences (MD) or odds ratios(OR) with I2 were calculated using either fixed or random-effect models. RESULTS: Six trials including 846 total cases were ultimately selected for meta-analysis. ET was associated with reduced blood loss (MD = -32.02; 95%CI: -36.92 to -27.12; P < 0.00001) and better cosmetic satisfaction (OR = 38.92; 95%CI: 17.40-87.06; P < 0.00001) than OT. However, OT was associated with reduced operation time (MD = 19.70; 95%CI: 2.04-37.35; P = 0.03) and lower hospital costs (MD = 303.21; 95%CI: 123.07, 483.36; P = 0.0010). Furthermore, ET and OT were not significantly different in terms of drainage volume, and they had an equivalent complication rate, including for transient recurrent laryngeal nerve palsy, transient hypocalcemia, postoperative hypothyroidism, and recurrent-hyperthyroidism. CONCLUSIONS: ET appeared to provide better cosmetic satisfaction and a reduction in blood loss, whereas OT had a shorter operation time and lower hospital costs. Randomized clinical trials with large samples that include long-term follow-up data are necessary to confirm our findings.
BACKGROUND: Despite experience with the use of endoscopic surgical technology, there is controversy over the role of endoscopic thyroidectomy (ET) for Graves' disease (GD). This study aimed to conduct a meta-analysis to evaluate the cosmetic and safety outcomes of ET versus conventional open thyroidectomy (OT) for GD with respect to short-term consequences. METHODS: We searched the following English language databases (Ovid MEDLINE, ISI Web of Science, and the Cochrane Library), and Chinese language databases (CNKI, CBMdisc, and SinoMed) between January 1996 and November 2015. The quality of the included studies was determined by the Newcastle-Ottawa Scale. A meta-analysis was conducted using RevMan 5.3 software. Pooled mean differences (MD) or odds ratios(OR) with I2 were calculated using either fixed or random-effect models. RESULTS: Six trials including 846 total cases were ultimately selected for meta-analysis. ET was associated with reduced blood loss (MD = -32.02; 95%CI: -36.92 to -27.12; P < 0.00001) and better cosmetic satisfaction (OR = 38.92; 95%CI: 17.40-87.06; P < 0.00001) than OT. However, OT was associated with reduced operation time (MD = 19.70; 95%CI: 2.04-37.35; P = 0.03) and lower hospital costs (MD = 303.21; 95%CI: 123.07, 483.36; P = 0.0010). Furthermore, ET and OT were not significantly different in terms of drainage volume, and they had an equivalent complication rate, including for transient recurrent laryngeal nerve palsy, transient hypocalcemia, postoperative hypothyroidism, and recurrent-hyperthyroidism. CONCLUSIONS: ET appeared to provide better cosmetic satisfaction and a reduction in blood loss, whereas OT had a shorter operation time and lower hospital costs. Randomized clinical trials with large samples that include long-term follow-up data are necessary to confirm our findings.