The Efficacy Of Endoscopic Thyroidectomy Via Oral Vestibular Approach Versus Anterior Chest Approach For Differentiated Thyroid Carcinoma:A Meta-analysis

Objective:To compare the clinical efficacy of endoscopic thyroidectomy via oral vestibular approach and anterior chest approach in the treatment of differentiated thyroid carcinoma.Methods:By searching Chinese and Foreign databases from the establishment of the database to September 2021,all literatures comparing endoscopic thyroidectomy via oral vestibular approach and anterior chest approach for differentiated thyroid carcinoma were collected.Relevant data and materials were extracted.Then,RevMan 5.4 software were used for meta-analysis.Results:Ten retrospective studies were finally included involving 942 patients,of whom 445 in oral vestibular approach group and 497 in anterior chest approach group.Meta-analysis results showed:compared with the anterior chest approach,the oral vestibular approach has the advantages of the less intraoperative blood loss[WMD=-0.89,95%CI(-1.62,-0.16),P=0.02]and the number of lymph node dissections in the central area was larger[WMD=0.94,95%CI(0.17,1.71),P=0.02],while the differences were statistically significant.There were no statistically differences in operative time[WMD=1.71,95%CI(-2.86,6.28),P=0.46],postoperative drainage volume[WMD=-5.79,95%CI(-12.09,0.51),P=0.07],and hospital stay[WMD=0.33,95%CI(-0.14,0.81),P=0.17].And the incidence of postoperative infection[OR=3.04 95%CI(0.79,11.66),P=0.10],postoperative hands and feet numbness(parathyroid injury)[OR=0.49,95%CI(0.15,1.62),P=0.24],postoperative water cough(superior laryngeal nerve injury)[OR=3.20,95%CI(0.89,11.49),P=0.07]and postoperative recurrent laryngeal nerve injury[OR=0.81,95%CI(0.32,2.06),P=0.65]were not significantly different between the two groups(P>0.05).Conclusion:The results of the two surgical approaches are similar in terms of clinical effectiveness and safety.And the oral vestibular approach has the advantages in the aspects of intraoperative blood loss and the number of lymph node dissections in the central area.Thus the oral vestibular approach is the better option for patients seeking scar-free.