Patient Eligibility for Transoral Endocrine Surgery Procedures in the United States
Patient Eligibility for Transoral Endocrine Surgery Procedures in the United States
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DOI：
10.1001/jamanetworkopen.2019.4829
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Russell, Jonathon O.
中科院分区：
文献类型：
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作者：
Grogan, Raymon H.;Suh, Insoo;Russell, Jonathon O.
重要性 经口内分泌手术 (TES) 允许进行甲状腺和甲状旁腺手术，而不会在身体上留下任何明显的疤痕。关于 TES 的价值仍然存在争议，部分原因是人们普遍认为 TES 仅适用于一小部分经过选择的患者。了解这些手术的整体适用性对于了解手术以及决定应分配多少精力和资源来进一步研究这些手术的安全性、有效性和价值至关重要。 目的 使用目前接受的排除标准，确定接受甲状腺和甲状旁腺手术的美国患者中有多少百分比有资格接受 TES。 设计、设置和参与者 对 7 月份期间进行的 1000 例连续甲状腺和甲状旁腺手术（有或没有颈清扫术）进行的横断面研究2015 年 1 月 1 日和 2018 年 7 月 1 日，在 3 场美国甲状腺和甲状旁腺重点学术手术实践中（2 场普外科、1 场耳鼻喉头颈内分泌手术）。 TES 的资格是通过回顾性地将之前发布的排除标准应用于病例来确定的。 主要结果和措施 主要结果是符合 TES 条件的甲状腺和甲状旁腺病例的百分比。次要结局是对符合条件的特定类型病例的百分比和不符合条件的原因进行亚组分析。 结果 1000 名手术患者的平均 (SD) 年龄为 53 (15) 岁，平均 (SD) 体重指数（以公斤体重除以米平方计算）为 29 (7)，其中 747 名患者 (75.0%) 为女性。 558 名 (55.8%) 患者符合 TES 资格。大多数具有细胞学不确定行为的甲状腺结节患者（217 例中的 165 例 [76.0%]）、良性甲状腺疾病（240 例中的 166 例 [69.2%]）和原发性甲状旁腺功能亢进症（273 例中的 158 例 [57.9%]）符合 TES 资格，但 231 例甲状腺癌患者中只有 67 例（29.0%）符合资格。在所有审查的 1000 例病例中，既往颈部手术（441 例中的 97 例 [22.0%]）、非局限性原发性甲状旁腺功能亢进（441 例中的 78 例 [17.7%]）和需要颈清扫术（441 例中的 66 例 [15.0%]）是不符合资格的最常见原因。 结论和相关性 本研究中接受甲状腺和甲状旁腺手术的所有患者中有一半以上符合资格对于TES。这种广泛的适用性表明前瞻性多中心试验对于明确研究 TES 的安全性、结果和成本是合理的。
IMPORTANCE Transoral endocrine surgery (TES) allows thyroid and parathyroid operations to be performed without leaving any visible scar on the body. Controversy regarding the value of TES remains, in part owing to the common belief that TES is only applicable to a small, select group of patients. Knowledge of the overall applicability of these procedures is essential to understand the operation, as well as to decide the amount of effort and resources that should be allocated to further study the safety, efficacy, and value of these operations.OBJECTIVE To determine what percentage of US patients undergoing thyroid and parathyroid surgery are eligible for TES using currently accepted exclusion criteria.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 1000 consecutive thyroid and parathyroid operations (with or without neck dissection) performed between July 1, 2015, and July 1, 2018, at 3 high-volume academic US thyroid-and parathyroid-focused surgical practices (2 general surgery, 1 otolaryngology-head and neck endocrine surgery). Eligibility for TES was determined by retrospectively applying previously published exclusion criteria to the cases.MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of thyroid and parathyroid cases eligible for TES. Secondary outcomes were a subgroup analysis of the percentage of specific types of cases eligible and the reasons for ineligibility.RESULTS The mean (SD) age of the 1000 surgical patients was 53 (15) years, mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 29 (7), and 747 (75.0%) of the patients were women. Five hundred fifty-eight (55.8%) of the patients were eligible for TES. Most patients with thyroid nodules with cytologically indeterminate behavior (165 of 217 [76.0%]), benign thyroid conditions (166 of 240 [69.2%]), and primary hyperparathyroidism (158 of 273 [57.9%]) were eligible for TES, but only 67 of 231 (29.0%) of patients with thyroid cancer were eligible. Among all 1000 cases reviewed, previous neck operation (97 of 441 [22.0%]), nonlocalized primary hyperparathyroidism (78 of 441 [17.7%]), and need for neck dissection (66 of 441 [15.0%]) were the most common reasons for ineligibility.CONCLUSIONS AND RELEVANCE More than half of all patients undergoing thyroid and parathyroid surgery in this study were eligible for TES. This broad applicability suggests that a prospective multicenter trial is reasonable to definitively study the safety, outcomes, and cost of TES.