TOETVA: a single surgeon's learning curve and a case report of CASTLE thyroid tumor.
CASTLE
Cumulative summation analysis
Learning curve
TOETVA
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
13 Oct 2023
13 Oct 2023
Historique:
received:
06
07
2023
accepted:
04
10
2023
medline:
1
11
2023
pubmed:
13
10
2023
entrez:
13
10
2023
Statut:
epublish
Résumé
Owing to the lack of visible scars, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers superior aesthetic outcomes compared to conventional thyroidectomy. Carcinoma showing thymus-like differentiation (CASTLE) represents a rare thyroid gland neoplasm. This study aimed to explore the TOETVA learning curve and present a case report of CASTLE. A study with precise 1:1 matching was conducted to assess the procedure safety and cancer control outcomes of TOETVA in comparison to conventional surgery between May 2020 and May 2023. Cumulative sum analysis was employed to optimally fit the learning curve. Subsequently, a case report of CASTLE treated with TOETVA surgery was presented. The mean operative time was longer in the TOETVA group than in the open group. The TOETVA group had a higher incidence of skin numbness and excellent cosmetic outcomes compared to the open group. The learning curves for work area preparation, unilateral thyroid lobectomy, and the entire surgical process were 59, 28, and 50 cases, respectively. There were no differences between the learning and proficient groups, except for operative time, intraoperative blood loss, and drainage volume on the first postoperative day. A comprehensive analysis of the TOETVA learning curve utilizing cumulative and analytical methods demonstrated the feasibility of TOETVA with regards to surgical integrity, safety, and oncological safety. This study's findings suggest that a surgeon's cumulative number of TOETVA cases exceeding 50 can reach the mastery stage. Moreover, diagnosing CASTLE is challenging and necessitates immunohistochemical detection of relatively specific markers associated with thymic epithelial tumors.
Sections du résumé
BACKGROUND
BACKGROUND
Owing to the lack of visible scars, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers superior aesthetic outcomes compared to conventional thyroidectomy. Carcinoma showing thymus-like differentiation (CASTLE) represents a rare thyroid gland neoplasm. This study aimed to explore the TOETVA learning curve and present a case report of CASTLE.
METHODS
METHODS
A study with precise 1:1 matching was conducted to assess the procedure safety and cancer control outcomes of TOETVA in comparison to conventional surgery between May 2020 and May 2023. Cumulative sum analysis was employed to optimally fit the learning curve. Subsequently, a case report of CASTLE treated with TOETVA surgery was presented.
RESULTS
RESULTS
The mean operative time was longer in the TOETVA group than in the open group. The TOETVA group had a higher incidence of skin numbness and excellent cosmetic outcomes compared to the open group. The learning curves for work area preparation, unilateral thyroid lobectomy, and the entire surgical process were 59, 28, and 50 cases, respectively. There were no differences between the learning and proficient groups, except for operative time, intraoperative blood loss, and drainage volume on the first postoperative day.
CONCLUSIONS
CONCLUSIONS
A comprehensive analysis of the TOETVA learning curve utilizing cumulative and analytical methods demonstrated the feasibility of TOETVA with regards to surgical integrity, safety, and oncological safety. This study's findings suggest that a surgeon's cumulative number of TOETVA cases exceeding 50 can reach the mastery stage. Moreover, diagnosing CASTLE is challenging and necessitates immunohistochemical detection of relatively specific markers associated with thymic epithelial tumors.
Identifiants
pubmed: 37831199
doi: 10.1007/s00423-023-03140-8
pii: 10.1007/s00423-023-03140-8
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
398Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249
doi: 10.3322/caac.21660
pubmed: 33538338
Udelsman R, Zhang Y (2014) The epidemic of thyroid cancer in the United States: the role of endocrinologists and ultrasounds. Thyroid Off J Am Thyroid Assoc 24:472–479
doi: 10.1089/thy.2013.0257
Liao D, Ishii LE, Chen LW, Chen J, Juarez M, Darrach HM, Kumar AR, Russell JO, Tufano RP, Ishii M (2020) Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery. Laryngoscope 130:1603–1608
pubmed: 31660610
doi: 10.1002/lary.28305
Choi Y, Lee JH, Kim YH, Lee YS, Chang HS, Park CS, Roh MR (2014) Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol 26:693–699
pubmed: 25473220
pmcid: 4252665
doi: 10.5021/ad.2014.26.6.693
Lee DW, Bang HS, Jeong JH, Kwak SG, Choi YY, Tae K (2021) Cosmetic outcomes after transoral robotic thyroidectomy: comparison with transaxillary, postauricular, and conventional approaches. Oral Oncol 114:105139
pubmed: 33460884
doi: 10.1016/j.oraloncology.2020.105139
Tae K (2020) Transoral thyroidectomy: is it a real game changer? Clin exp otorhinolaryngol 13:93–94
pubmed: 32434309
pmcid: 7248618
doi: 10.21053/ceo.2020.00402
Fernandez-Ranvier G, Meknat A, Guevara DE, Inabnet WB, 3rd (2019) Transoral endoscopic thyroidectomy vestibular approach. JSLS: J Soc Laparoendosc Surg 23
Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, Tian HW, Feng SW, Han CW, Yang J, Yang KH, Guo TK (2020) Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc 34:1891–1903
pubmed: 32144555
doi: 10.1007/s00464-019-07283-y
Lee SJ, Ryu SR, Ji YB, Song CM, Park JH, Kim DS, Tae K (2023) Five-year oncologic outcome and surgical completeness of transoral robotic thyroidectomy for papillary thyroid carcinoma: comparison with conventional transcervical thyroidectomy using propensity score matching. Ann Surg Oncol 30:2256–2264
pubmed: 36602660
doi: 10.1245/s10434-022-13020-y
Tae K (2021) Complications of transoral thyroidectomy: overview and update. Clin Exp Otorhinolaryngol 14:169–178
pubmed: 33211953
doi: 10.21053/ceo.2020.02110
Chan JK, Rosai J (1991) Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Hum Pathol 22:349–367
pubmed: 2050369
doi: 10.1016/0046-8177(91)90083-2
Dualim DM, Loo GH, Suhaimi SNA, Md Latar NH, Muhammad R, Abd Shukor N (2019) The “CASTLE” tumour: an extremely rare presentation of a thyroid malignancy. A case report. Ann Med Surg 44:57–61
doi: 10.1016/j.amsu.2019.06.013
Liu Z, Teng XY, Sun DX, Xu WX, Sun SL (2013) Clinical analysis of thyroid carcinoma showing thymus-like differentiation: report of 8 cases. Int Surg 98:95–100
pubmed: 23701142
pmcid: 3723174
doi: 10.9738/INTSURG-D-12-00034.1
Tae K, Ji YB, Song CM, Park JS, Park JH, Kim DS (2020) Safety and efficacy of transoral robotic and endoscopic thyroidectomy: the first 100 cases. Head Neck 42:321–329
pubmed: 31682312
doi: 10.1002/hed.25999
Yi L, Liu ZY, Peng XW, Li Z, Zhou B, Lyu CL, Song DJ, Tang YY, Wu P, Li H, Peng W, Li M (2020) Indications and contraindications for transoral endoscopic thyroidectomy by vestibular approach. Zhonghua er bi yan hou tou jing wai ke za zhi Chin J Otorhinolaryngol Head Neck Surg 55:975–979
Sugitani I, Ito Y, Takeuchi D, Nakayama H, Masaki C, Shindo H, Teshima M, Horiguchi K, Yoshida Y, Kanai T, Hirokawa M, Hames KY, Tabei I, Miyauchi A (2021) Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: consensus statements from the Japan Association of Endocrine Surgery Task Force on management for papillary thyroid microcarcinoma. Thyroid Off J Am Thyroid Assoc 31:183–192
doi: 10.1089/thy.2020.0330
Kantor J (2016) The SCAR (Scar Cosmesis Assessment and Rating) scale: development and validation of a new outcome measure for postoperative scar assessment. Br J Dermatol 175:1394–1396
pubmed: 27292082
doi: 10.1111/bjd.14812
Ouyang H, Xue W, Zhang Z, Cong R, Sun B, Xia F, Li X (2022) Learning curve for robotic thyroidectomy using BABA: CUSUM analysis of a single surgeon’s experience. Front Endocrinol 13:942973
doi: 10.3389/fendo.2022.942973
Morato O, Poves I, Burdio F, Sanchez-Velazquez P, Duran X, Grande L (2020) Evaluation of the learning curve for laparoscopic pancreatoduodenectomy by CUSUM analyses. Cohort study Int J Surg 80:61–67
pubmed: 32650295
doi: 10.1016/j.ijsu.2020.05.009
Sultana A, Nightingale P, Marudanayagam R, Sutcliffe RP (2019) Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM. HPB (Oxford) 21:1505–1512
pubmed: 30992198
doi: 10.1016/j.hpb.2019.03.362
Kandil E, Akkera M, Shalaby H, Munshi R, Attia A, Elnahla A, Shalaby M, Abdelgawad M, Grace L, Kang SW (2021) A Single surgeon’s 10-year experience in remote-access thyroid and parathyroid surgery. Am Surg 87:638–644
pubmed: 33142070
doi: 10.1177/0003134820950300
Witzel K, von Rahden BH, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875
pubmed: 18163167
doi: 10.1007/s00464-007-9734-6
Wilhelm T, Metzig A (2011) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35:543–551
pubmed: 21088839
doi: 10.1007/s00268-010-0846-0
Karakas E, Steinfeldt T, Gockel A, Schlosshauer T, Dietz C, Jager J, Westermann R, Sommer F, Richard HR, Exner C, Sesterhenn AM, Bartsch DK (2011) Transoral thyroid and parathyroid surgery–development of a new transoral technique. Surgery 150:108–115
pubmed: 21458014
doi: 10.1016/j.surg.2010.12.016
Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2018) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27
pubmed: 28877292
doi: 10.1001/jamasurg.2017.3366
Zheng G, Ma C, Sun H, Wu G, Guo Y, Wu G, Zheng H (2021) Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: a two-centre study. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 47:1346–1351
Wang T, Wu Y, Xie Q, Yan H, Zhou X, Yu X, Chen Y, Xiang C, Yan H, Zhao Q, Zhang M, Qi M, Wang P, Wang Y (2020) Safety of central compartment neck dissection for transoral endoscopic thyroid surgery in papillary thyroid carcinoma. Jpn J Clin Oncol 50:387–391
pubmed: 31829423
doi: 10.1093/jjco/hyz195
Sun H, Wang X, Zheng G, Wu G, Zeng Q, Zheng H (2022) 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. Front Oncol 12:856021
pubmed: 35311081
pmcid: 8925319
doi: 10.3389/fonc.2022.856021
Sun H, Zheng H, Wang X, Zeng Q, Wang P, Wang Y (2020) 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. Surg Endosc 34:268–274
pubmed: 31346748
doi: 10.1007/s00464-019-06762-6
Hong YT, Ahn JH, Kim JH, Yi JW, Hong KH (2020) Bi-institutional experience of transoral endoscopic thyroidectomy: challenges and outcomes. Head Neck 42:2115–2122
pubmed: 32212365
doi: 10.1002/hed.26153
Liang TJ, Tsai CY, Liu SI, Chen IS (2021) Multidimensional analyses of the learning curve of endoscopic thyroidectomy. World J Surg 45:1446–1456
pubmed: 33512565
doi: 10.1007/s00268-021-05953-4
Sun B, Li P, Cong R, Zhou D, Zhang Z, Xia F, Li X (2022) Gasless endoscopic transaxillary thyroid surgery: CUSUM analysis of a single surgeon’s experience from 105 preliminary procedures. Surg Endosc 36:8270–8279
pubmed: 35680669
doi: 10.1007/s00464-022-09273-z
Chai YJ, Chae S, Oh MY, Kwon H, Park WS (2021) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): surgical outcomes and learning curve. J Clin Med 10
Kim KH, Ji YB, Song CM, Kim E, Kim KN, Tae K (2023) Learning curve of transoral robotic thyroidectomy. Surg Endosc 37:535–543
pubmed: 36002679
doi: 10.1007/s00464-022-09549-4
Lira RB, Ramos AT, Nogueira RMR, de Carvalho GB, Russell JO, Tufano RP, Kowalski LP (2020) Transoral thyroidectomy (TOETVA): complications, surgical time and learning curve. Oral Oncol 110:104871
pubmed: 32619928
doi: 10.1016/j.oraloncology.2020.104871
Lee MJ, Oh MY, Lee JM, Sun J, Chai YJ (2023) Comparative surgical outcomes of transoral endoscopic and robotic thyroidectomy for thyroid carcinoma: a propensity score-matched analysis. Surg Endosc 37:1132–1139
pubmed: 36131160
doi: 10.1007/s00464-022-09636-6
Erol V, Dionigi G, Barczynski M, Zhang D, Makay O (2020) Intraoperative neuromonitoring of the RLNs during TOETVA procedures. Gland Surg 9:S129–S135
pubmed: 32175253
pmcid: 7044085
doi: 10.21037/gs.2019.11.21
Chen S, Zhao M, Qiu J (2019) Transoral vestibule approach for thyroid disease: a systematic review. Eur Arch oto-rhino-laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc 276:297–304
doi: 10.1007/s00405-018-5206-y
Arikan M, Riss P, European TSG (2023) Transoral thyroidectomy: initial results of the European TOETVA study group. World J Surg 47:1201–1208
pubmed: 36799993
pmcid: 10070222
doi: 10.1007/s00268-023-06932-7
Zheng G, Xu J, Wu G, Ma C, Sun H, Ge M, Zheng H, Zheng C (2022) Transoral versus gasless transaxillary endoscopic thyroidectomy: a comparative study. Updat Surg 74:295–302
doi: 10.1007/s13304-021-01062-y
Park JH, Bilegsaikhan SE, Suh YJ (2020) A novel technique for performing transoral endoscopic thyroidectomy vestibular approach (TOETVA): A single-port platform. Surg laparosc Endosc Percutaneous Tech 30:e4–e7
doi: 10.1097/SLE.0000000000000739
de Cillia M, Obrist C, Mittermair C, Karakas E, Weiss H (2022) Flexible single port access in transoral endoscopic thyroidectomy vestibular approach. Gland Surg 11:778–787
pubmed: 35694100
pmcid: 9177271
doi: 10.21037/gs-21-818
Yeh YT, Chen JY, Kuo PC, Wang TH, Lee HC, Chi CW, Lee CH, Shyr YM, Wang SJ, Chen WM (2020) Printing a three-dimensional patient-specific safety device for reducing the potential risk of mental nerve injury during transoral thyroidectomy. World J Surg 44:371–377
pubmed: 31531721
doi: 10.1007/s00268-019-05155-z
Anuwong A, Kim HY, Dionigi G (2017) Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg 6:277–284
pubmed: 28713700
pmcid: 5503927
doi: 10.21037/gs.2017.03.16
Roh MR (2016) The SCAR (Scar Cosmesis Assessment and Rating) scale: new evaluation method for postoperative scars. Br J Dermatol 175:1151–1152
pubmed: 27996133
doi: 10.1111/bjd.14989
Kantor J (2017) Reliability and photographic equivalency of the Scar Cosmesis Assessment and Rating (SCAR) scale, an outcome measure for postoperative scars. JAMA Dermatol 153:55–60
pubmed: 27806156
doi: 10.1001/jamadermatol.2016.3757
Ito Y, Miyauchi A (2023) Active surveillance may be the best initial management for papillary thyroid microcarcinoma. J Endocr Soc 7:bvad063
Kuo TC, Duh QY, Wang YC, Lai CW, Chen KY, Lin MT, Wu MH (2021) Practice Patterns and learning curve in transoral endoscopic thyroidectomy vestibular approach with neuromonitoring. Front Endocrinol 12:744359
doi: 10.3389/fendo.2021.744359
Bai B, Chen W (2018) Protective effects of intraoperative nerve monitoring (IONM) for recurrent laryngeal nerve injury in thyroidectomy: meta-analysis. Sci Rep 8:7761
pubmed: 29773852
pmcid: 5958090
doi: 10.1038/s41598-018-26219-5
Marini A, Kanakis M, Valakis K, Laschos N, Chorti M, Lioulias A (2016) Thyroid carcinoma showing thymic-like differentiation causing fracture of the trachea. Case Rep Med 2016:7962385
pubmed: 27110248
pmcid: 4826678
doi: 10.1155/2016/7962385
Gao R, Jia X, Ji T, Feng J, Yang A, Zhang G (2018) Management and prognostic factors for thyroid carcinoma showing thymus-like elements (CASTLE): a case series study. Front Oncol 8:477
pubmed: 30416983
pmcid: 6212596
doi: 10.3389/fonc.2018.00477
Stanciu M, Ristea RP, Popescu M, Vasile CM, Popa FL (2022) Thyroid carcinoma showing thymus-like differentiation (CASTLE): a case report. Life 12
Jiang L, Zheng WH, Chen C (2022) Genomic variation associated with carcinoma showing thymus-like elements (CASTLE) in thyroid gland. Laryngosc Invest otolaryngol 7:894–900
doi: 10.1002/lio2.805
Zhang G, Liu X, Huang W, Li X, Johnstone M, Deng Y, Ke Y, Nunes QM, Wang H, Wang Y, Zhang X (2015) Carcinoma showing thymus-like elements of the thyroid gland: report of three cases including one case with breast cancer history. Pathol Oncol Res POR 21:45–51
pubmed: 25432547
doi: 10.1007/s12253-014-9772-z
Kunc M, Kamieniecki A, Walczak G, Nowicki T, Wasag B, Mikaszewski B, Stodulski D, Biernat W (2022) Intrasalivary thymic carcinoma: a case report and literature review. Head Neck Pathol 16:857–864
pubmed: 34807356
doi: 10.1007/s12105-021-01394-6
Wang YF, Liu B, Fan XS, Rao Q, Xu Y, Xia QY, Yu B, Shi SS, Zhou XJ (2015) Thyroid carcinoma showing thymus-like elements: a clinicopathologic, immunohistochemical, ultrastructural, and molecular analysis. Am J Clin Pathol 143:223–233
pubmed: 25596248
doi: 10.1309/AJCPB7PS6QHWEFRK
Kimura E, Enomoto K, Kono M, Tamagawa S, Takeda S, Kumashiro N, Hirayama S, Kimura T, Hotomi M (2021) A rare case of thyroid carcinoma showing thymus-like differentiation in a young adult. Case Rep Oncol 14:671–675
pubmed: 33976651
pmcid: 8077592
doi: 10.1159/000514271
Cheon T, Song YJ, Kim JI, Cha HJ, Han MW (2019) Aggressive thyroid carcinoma showing thymus-like differentiation (CASTLE) with lung metastasis and carotid artery invasion. Ear Nose Throat J 98:557–559
pubmed: 31284751
doi: 10.1177/0145561319858056
Kovarova P, Vojtisek R, Krcma M, Daum O, Baxa J, Sukovska E, Finek J (2021) Inoperable CASTLE of the thyroid gland treated with radical radiotherapy with complete remission. Strahlenther Onkol Organ Dtsch Rontgengesellschaft [et al] 197:847–853
doi: 10.1007/s00066-021-01800-6