连续癌症富集队列1000例患者的经口腔甲状腺切除术：单外科医生使用内镜和机器人平台的经验。

文献信息

中文摘要

引言： 经口腔前庭甲状腺切除术，通过内镜（经口腔前庭入路内镜甲状腺切除术[TOETVA]）或机器人辅助（经口腔机器人甲状腺切除术[TORT]）入路进行，是一种隐藏疤痕的开放甲状腺切除术替代方案。鉴于涵盖两种平台的大规模单外科医生研究匮乏，本研究旨在描述大型癌症富集经口腔甲状腺切除术系列的临床病理学和围手术期结局，并检查TOETVA与TORT之间的差异。
方法： 我们回顾性审查了2016年9月至2024年5月期间由单一内分泌外科医生实施的1000例连续患者，其中TOETVA（n=450）或TORT（n=550）。在TORT引入后的同期队列中，进行了额外的倾向评分匹配分析，纳入临床特征和日历时间，并对手术范围进行精确匹配，产生221对匹配。
结果： 在1000例中，986例（98.6%）为恶性，主要为甲状腺乳头状癌，99.8%为病理I期。总体围手术期结局可接受，并发症率低，引流使用不频繁；喉返神经麻痹和颏神经损伤仅限于早期TOETVA时期。在总体队列中，TORT患者肿瘤较大，T1b和N1a疾病更频繁，手术时间和住院时间较短。倾向评分匹配后，平台间差异适中：TORT与手术时间延长5.05分钟（95% CI，0.39-9.72）和中央区淋巴结产量增加0.79个（95% CI，0.18-1.41）相关，而组织病理学特征、住院时间和测量的术后并发症无显著差异。敏感性分析得出相似的手术时间估计。
结论： 在这个大型癌症富集单外科医生队列中，经口腔甲状腺切除术在精心选择的患者中与可接受的围手术期结局相关。尽管TOETVA和TORT在总体队列中显示出差异，但调整后差异适中，并未确立任一平台的优越性。两种方法在不断发展的经口腔甲状腺切除术实践中可能保留实用价值。

英文摘要

INTRODUCTION: Transoral vestibular thyroidectomy, performed using an endoscopic (transoral endoscopic thyroidectomy via the vestibular approach [TOETVA]) or robot-assisted (transoral robotic thyroidectomy [TORT]) approach, is a scar-concealing alternative to open thyroidectomy. Given the paucity of large-scale single-surgeon studies spanning both platforms, the aim of this study was to characterize the clinicopathological and perioperative outcomes of a large cancer-enriched transoral thyroidectomy series and to examine differences between TOETVA and TORT.
METHODS: We retrospectively reviewed 1-000 consecutive patients who underwent TOETVA (n=450) or TORT (n=550) performed by a single endocrine surgeon between September 2016 and May 2024. An additional propensity score-matched analysis incorporating clinical characteristics and calendar time, with exact matching on extent of surgery, was performed in the contemporaneous cohort after TORT introduction, yielding 221 matched pairs.
RESULTS: Among the 1-000 cases, 986 (98.6%) were malignant, predominantly papillary thyroid carcinoma, with 99.8% at pathological stage I. Overall perioperative outcomes were acceptable, with low complication rates and infrequent drain use; recurrent laryngeal nerve palsy and mental nerve injury were confined to the early TOETVA period. In the overall cohort, TORT patients had larger tumors and more frequent T1b and N1a disease, with shorter operative time and hospital stay. After propensity score matching, between-platform differences were modest: TORT was associated with a 5.05-min longer operative time (95% CI, 0.39-9.72) and a 0.79-node higher central compartment node yield (95% CI, 0.18-1.41), whereas histopathological characteristics, hospital stay, and measured postoperative complications did not differ significantly. Sensitivity analyses yielded similar operative-time estimates.
CONCLUSIONS: In this large cancer-enriched single-surgeon cohort, transoral thyroidectomy was associated with acceptable perioperative outcomes in carefully selected patients. Although TOETVA and TORT showed differences in the overall cohort, adjusted differences were modest and did not establish superiority of either platform. Both approaches may retain practical value within an evolving transoral thyroidectomy practice.