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Objectives <p>The efficacy and safety of different surgical approaches to thyroidectomy with lateral neck dissection remain unclear. This study aims to evaluate five endoscopic and open techniques for thyroidectomy with lateral neck dissection and identify the most effective method.</p> Methods <p>A systematic search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library for studies comparing different surgical approaches across multiple outcome indicators. The risk of bias was analyzed, and publication bias was assessed using funnel plot asymmetry tests. Both global and local inconsistency tests were performed to evaluate the agreement between direct and indirect comparisons. Pairwise and network meta-analyses were conducted for each outcome, with approaches ranked using Surface Under the Cumulative Ranking (SUCRA) values and curves.</p> Results <p>A total of 1251 patients across 13 clinical studies were included in the analysis. No significant statistical differences were found among the approaches for lymph node dissection and postoperative recurrence rates. The bilateral axillary breast approach yielded the highest number of lymph nodes (SUCRA value: 0.762). The suprasternal fossa approach had the lowest postoperative recurrence rate (SUCRA: 0.657) and performed well in metastatic lymph node dissection (SUCRA: 0.679). The bilateral axillary breast approach significantly reduced postoperative complication rates compared to the open and transaxillary approaches (mean differences: − 1.88 and − 0.23; 95% confidence intervals: − 3.87 to − 0.46 and − 0.62 to 0.29, respectively) and was the most effective in minimizing complications (SUCRA: 0.910). Open surgery demonstrated a significantly shorter operative duration.</p> Conclusion <p>Endoscopic approaches are viable and safe alternatives to open surgery, with fewer postoperative complications, albeit at the cost of longer operative durations.</p>

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Implications of five endoscopic and conventional open surgery on lateral neck dissection outcomes in patients with papillary thyroid carcinoma: a network meta-analysis and systematic review

  • 期刊论文

  • 发表日期：

    2025年2月6日

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  • Yao Tong,
  • Pengyu Li,
  • Wenrong Liu,
  • Shuangyan Tan,
  • Xiaofei Wang,
  • Yifan Zhang,
  • Yanhao Ran,
  • Yiqiao Fang,
  • Yuanyuan Fan,
  • Tao Wei,
  • Wanjun Zhao

摘要

Objectives

The efficacy and safety of different surgical approaches to thyroidectomy with lateral neck dissection remain unclear. This study aims to evaluate five endoscopic and open techniques for thyroidectomy with lateral neck dissection and identify the most effective method.

Methods

A systematic search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library for studies comparing different surgical approaches across multiple outcome indicators. The risk of bias was analyzed, and publication bias was assessed using funnel plot asymmetry tests. Both global and local inconsistency tests were performed to evaluate the agreement between direct and indirect comparisons. Pairwise and network meta-analyses were conducted for each outcome, with approaches ranked using Surface Under the Cumulative Ranking (SUCRA) values and curves.

Results

A total of 1251 patients across 13 clinical studies were included in the analysis. No significant statistical differences were found among the approaches for lymph node dissection and postoperative recurrence rates. The bilateral axillary breast approach yielded the highest number of lymph nodes (SUCRA value: 0.762). The suprasternal fossa approach had the lowest postoperative recurrence rate (SUCRA: 0.657) and performed well in metastatic lymph node dissection (SUCRA: 0.679). The bilateral axillary breast approach significantly reduced postoperative complication rates compared to the open and transaxillary approaches (mean differences: − 1.88 and − 0.23; 95% confidence intervals: − 3.87 to − 0.46 and − 0.62 to 0.29, respectively) and was the most effective in minimizing complications (SUCRA: 0.910). Open surgery demonstrated a significantly shorter operative duration.

Conclusion

Endoscopic approaches are viable and safe alternatives to open surgery, with fewer postoperative complications, albeit at the cost of longer operative durations.