RESUMO
Trans oral video-assisted thyroidectomy (TOVAT) is increasingly performed for cosmetic reasons. The quality of life after thyroidectomy is important for decision-making. This is the first meta-analysis to compare the quality of life among conventional transcervical thyroidectomies. This meta-analysis aimed to assess the same in the current literature. The authors systematically searched PubMed, Google Scholar, and EBSCO for relevant articles from the first published to December 4, 2022. The keywords endoscopic transoral via vestibular thyroidectomy, transcervical thyroidectomy, conventional thyroidectomy, scarless thyroidectomy, and quality of life were used. Out of the 482 studies retrieved, 27 full texts were reviewed, and only six fulfilled the inclusion and exclusion criteria. Patients with transoral thyroidectomy showed better quality of life that their counterparts who underwent transcervical thyroidectomy at 4-6 weeks following surgery, odd ratio, 2.26, 95% CI, 2.02-2.5, P-value <0.001. Substantial heterogeneity was observed, I2 for heterogeneity, 100%. The quality of life was better among patients who underwent the trans oral video-assisted thyroidectomy (TOVAT) compared to their counterparts with the conventional cervical approach (surgical questionnaire). All the components of the SF-36 quality of life questionnaire were better among TOVAT compared to the conventional approach except for social and general health components, which were equal between the two arms. Further multi-center studies with larger samples and controlling for pain and the surgical curve are needed.
RESUMO
Radioactive iodine (RAI) is widely used for remnant ablation in low/intermediate differentiated thyroid carcinoma (DTC). However, the optimal effective dose that overweighs the benefits over unwanted side effects is a matter of controversy. This meta-analysis aimed to assess low versus high doses of RAI activity for DTC remnant ablation. Two authors independently searched PubMed and Cochrane Library using the keywords low dose radioactive iodine, high dose radioactive iodine, low-risk/intermediate risk, differentiated thyroid carcinoma, and remnant ablation. Two hundred and twenty references were identified when limiting the engine to controlled trials in English and during the period from January 2010 to December 2020. Nine trials (five from Europe and four from Asia) including 3137 patients fulfilled the inclusion and exclusion criteria. The data were then entered in an extraction sheet detailing the trial information including the author's name, year of publication, country, and type of surgery, preparation for RAI, the patients and control number in the low and high-dose groups, follow-up period, and the results. Out of 220 articles retrieved, nine controlled trials were included (follow-up period range, six months to 12 years, 3137 patients, and low risk of bias). The analysis favored the high dose for remnants ablation, odd ratio, 0.73, 95% CI, 0.50-1.07; P-value for the overall effect was 0.10. However, the results were limited due to the significant heterogeneity observed (56%, P-value 0.03). High-dose RAI was better for DTC remnants ablation. Further studies focusing on intermediate-risk DTC and adjusting for preoperative and postoperative factors are recommended.
RESUMO
Lobectomy is increasingly performed for low-risk differentiated thyroid cancer (DTC) and papillary thyroid microcarcinoma (PTMC). However, there is a continuous controversy about completion thyroidectomy (CT) following lobectomy. The current meta-analysis aimed to assess the outcomes of the initial surgical procedure versus CT performed for low/intermediate-risk thyroid carcinoma. Six hundred and sixty-one articles were retrieved, and only 15 full texts fulfilled the inclusion and exclusion criteria. There were 15 studies, including 17,143 patients; twelve were retrospective, two prospective studies, and a controlled trial. Seven articles were from Asia, four from the USA, two from Europe, while two were published in Canada. The studies showed no difference between lobectomy and primary thyroid surgery regarding post-surgery complications. CT was not different from the initial surgical procedure in terms of complications for DTC. The study was limited by the retrospective studies included, the outcomes assessed were not uniform, and significant heterogeneity was observed. Further, well-controlled, more specific trials are needed.
RESUMO
Radioactive iodine (RAI) is being increasingly used for remnants ablation of low/intermediate-risk differentiated thyroid carcinoma (DTC). Importantly, total thyroidectomy (TT) is in common use in the treatment of low-grade DTC to facilitate RAI despite the recommendations for lobectomy. Intermediate-risk DTC has been an arena of controversy (fueled by weighing the risks and benefits of RAI). This meta-analysis aimed to assess the role of RAI following TT in comparison to lobectomy in low/intermediate-risk patients with DTC. We identified 482 references through PubMed, Cochrane Library, EBSCO, and Google Scholar databases. The keywords used were "differentiated thyroid carcinoma", "low/intermediate risk", "radioactive iodine following total thyroidectomy", "total thyroidectomy versus lobectomy and RAI", "remnants ablation", "recurrence", "survival rate", "tumor-specific cancer death", "overall mortality", and "tumor-specific mortality". From the 67 full texts screened, only seven studies fulfilled the inclusion and exclusion criteria. The studies were from the USA, Australia, Asia, Mexico, and South America (63,268 patients included; five were retrospective and two prospective cohorts). No differences were found regarding recurrence and survival rate between TT followed by RAI and lobectomy alone. However, the current data were limited by the observational studies included, the pooling of both recurrence and survival rate, and the significant heterogeneity observed. The ongoing randomized controlled trials are awaited to resolve the issue.
