A comparison of Quality of life between open and endoscopic thyroidectomy for papillary thyroid cancer.
MyungChul Lee, MD, PhD, Hoon Park, MD, Byeong-Cheol Lee, MD, Guk-Haeng Lee, MD, PhD, IkJoon Choi, MD
Department of Otolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
Running Title: QoL between conventional and endoscopic thyroidectomy Address for correspondence: IkJoon Choi, MD Department of Otolaryngology-Head and Neck Surgery Korea Cancer Center Hospital 75 Nowon-gil, Nowon-gu, Seoul, 139-706 Korea Tel: +82-2-970-1233 Fax: +82-2-970-2450 E-mail: [email protected]
Keywords Quality of life, Thyroid cancer, Endoscopic, Thyroidectomy
Word count: 1641
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as an ‘Accepted Article’, doi: 10.1002/hed.24108 This article is protected by copyright. All rights reserved.
Head & Neck
Abstract
Background Recently, various endoscopic thyroidectomy (ET) techniques have been introduced for cosmetic purposes. However, few reports have compared the quality of life (QOL )between post ET and post conventional open thyroidectomy (OT).In this study, we investigated whether ET was comparable to conventional OT with respect to QOL. Methods Between January 2010 and September 2011, 75 patients underwent endoscopic thyroid lobectomy and 233 patients underwent conventional open thyroid lobectomy. The QOL was assessed preoperatively and at 1, 3, and 6 months postoperatively by using the EORTC QLQ-C30 instruments. Results Both groups showed similar changes over time in most of the QOL scales. However,
ET patients showed significantly greater improvement in emotional
function at 1 month(P =0.039) and physical function at 3months(P =0.032).But, pain increased more in ET patients at 1 month (P =0.042) Conclusion Current findings suggest that ET may offer more rapid recovery of emotional and physical function than OT.
1
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Introduction
The development of an early screening test has resulted in a trend towards a rapid increase in the incidence of small-sized thyroid cancer in several parts of the world [12].Thyroid lobectomy is an established treatment modality for a small welldifferentiated thyroid cancer [3] because, compared to total thyroidectomy, it has shown similar oncologic results in addition to many advantages such as less complications and a lower requirement for synthetic thyroid hormone medication. Nevertheless, thyroid lobectomy results in a neck scar, and this cosmetic problem is the most common complaint among patients [8-10]. Recently, various techniques have been introduced to reduce the neck scar after thyroid surgery, and one of these techniques is the endoscopic approach. Endoscopic thyroid surgery was first performed by Huscher et al [3]. The cosmetic results of endoscopic thyroid surgery have been shown to be superior to those of conventional thyroid surgery [9]. Generally, the endoscopic technique is considered to be less invasive and has a rapid recovery that is similar to laparoscopic or thoracoscopic surgery. However, some surgeons think that endoscopic thyroid surgery is more invasive and has a slower
2
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Head & Neck
recovery compared to conventional thyroid surgery [4, 5]. The aim of this non-randomized, observational, longitudinal study was to compare the quality of life (QOL) outcomes among patients treated with endoscopic thyroid lobectomy (ET) relative to those who received conventional open thyroid lobectomy (OT).
Material and methods
Patients From January 2010 to September 2011, 709 patients received unilateral thyroid lobectomy with or without central node dissection for papillary thyroid cancer (PTC) at Korea Cancer Center Hospital, and these patients were assessed for inclusion in the study. The indications for ET were as follows: differentiated microcarcinoma with low risk (age 15–45 years, no prior radiation, no distant metastases, no cervical lymph node metastases clinically, no extrathyroidal extension clinically, and a nonaggressive variant) and patents who didn’t want to leave neck scar. The indications for OT were as follows: differentiated microcarcinoma with low risk (age 15–45 years, no prior radiation, no distant metastases, no cervical lymph node metastases clinically, no extrathyroidal
3
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Page 4 of 19
Page 5 of 19
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extension clinically, and a nonaggressive variant) but patents who didn’t want to perform endoscopic surgery regardless of scar formation. Patients were excluded if they (1) underwent total thyroidectomy, (2) neck dissection beyond central neck dissection. The following 3 different techniques were adapted for ET: the bilateral axillo-breast approach (BABA) with gas [8], the unilateral axillo-breast approach (UABA) without gas [9], and the UABA with gas [10].
Measures In the current study, QOL was measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 (EORTC QLQ-C30 ver. 3.0), which was developed in 1993 for the generic measurement of QOL in cancer patients [6]. It contains 30 cancer-specific questions that can be categorized into 1 global scale, 5 functional scales (physical, role, emotional, cognitive, and social), 3 symptom scales (fatigue, nausea and vomiting, and pain), and 6 single-item scales (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties) [7]. QOL was measured by using a validated Korean version of the EORTC QLQ-C30 version 3.0 4times in a row (preoperatively and at 1, 3, and 6 months post-operatively). All of items were scored and missing data were managed according to the EORTC
4
John Wiley & Sons, Inc. This article is protected by copyright. All rights reserved.
Head & Neck
Page 6 of 19
QLQ-C30 Scoring Manual [12]. A change over time of 0-4 points on the EORTC QLQ-C30 scales was not considered a clinically meaningful difference, whereas a mean change of 5-10 points was classified as a small change; 11-19 points was considered a moderate change; and 20 points or more was considered a large change[13]. All statistical analyses were performed by using the SPSS v12.0 for Windows software (SPSS Inc., Chicago, IL). To compare the 2 treatment groups on clinical and demographic variables, the independent t test and the ANOVA test were used for continuous data and the Fisher’s exact test or the chi-squared test was used for categorical data. Within each treatment group, differences in QOL from baseline (the preoperative score) were calculated using paired
t-test. Differences between the
groups in mean change scores were compared using ANOVA test.
Results
Patient characteristics The 401 of 709 eligible patients who underwent unilateral thyroid lobectomy were excluded from the analyses due to missing QOL questionnaires. Because they refused to
5
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Page 7 of 19
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enroll in this study, they were not administered any of the questionnaires). These patients didn’t show significantly differences from the 308 participants enrolled in available clinical or demographic variables (data not shown). Among the 308 patients enrolled in this study, 233 underwent conventional open thyroid lobectomy(OT group) and 75 underwent endoscopic thyroid lobectomy (ET group). The mean ages of the patients were 42.2±8.6 years in the ET group and 52.1±9.3 years in the OT group(P
MyungChul Lee, MD, PhD, Hoon Park, MD, Byeong-Cheol Lee, MD, Guk-Haeng Lee, MD, PhD, IkJoon Choi, MD
Department of Otolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
Running Title: QoL between conventional and endoscopic thyroidectomy Address for correspondence: IkJoon Choi, MD Department of Otolaryngology-Head and Neck Surgery Korea Cancer Center Hospital 75 Nowon-gil, Nowon-gu, Seoul, 139-706 Korea Tel: +82-2-970-1233 Fax: +82-2-970-2450 E-mail: [email protected]
Keywords Quality of life, Thyroid cancer, Endoscopic, Thyroidectomy
Word count: 1641
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as an ‘Accepted Article’, doi: 10.1002/hed.24108 This article is protected by copyright. All rights reserved.
Head & Neck
Abstract
Background Recently, various endoscopic thyroidectomy (ET) techniques have been introduced for cosmetic purposes. However, few reports have compared the quality of life (QOL )between post ET and post conventional open thyroidectomy (OT).In this study, we investigated whether ET was comparable to conventional OT with respect to QOL. Methods Between January 2010 and September 2011, 75 patients underwent endoscopic thyroid lobectomy and 233 patients underwent conventional open thyroid lobectomy. The QOL was assessed preoperatively and at 1, 3, and 6 months postoperatively by using the EORTC QLQ-C30 instruments. Results Both groups showed similar changes over time in most of the QOL scales. However,
ET patients showed significantly greater improvement in emotional
function at 1 month(P =0.039) and physical function at 3months(P =0.032).But, pain increased more in ET patients at 1 month (P =0.042) Conclusion Current findings suggest that ET may offer more rapid recovery of emotional and physical function than OT.
1
John Wiley & Sons, Inc. This article is protected by copyright. All rights reserved.
Page 2 of 19
Page 3 of 19
Head & Neck
Introduction
The development of an early screening test has resulted in a trend towards a rapid increase in the incidence of small-sized thyroid cancer in several parts of the world [12].Thyroid lobectomy is an established treatment modality for a small welldifferentiated thyroid cancer [3] because, compared to total thyroidectomy, it has shown similar oncologic results in addition to many advantages such as less complications and a lower requirement for synthetic thyroid hormone medication. Nevertheless, thyroid lobectomy results in a neck scar, and this cosmetic problem is the most common complaint among patients [8-10]. Recently, various techniques have been introduced to reduce the neck scar after thyroid surgery, and one of these techniques is the endoscopic approach. Endoscopic thyroid surgery was first performed by Huscher et al [3]. The cosmetic results of endoscopic thyroid surgery have been shown to be superior to those of conventional thyroid surgery [9]. Generally, the endoscopic technique is considered to be less invasive and has a rapid recovery that is similar to laparoscopic or thoracoscopic surgery. However, some surgeons think that endoscopic thyroid surgery is more invasive and has a slower
2
John Wiley & Sons, Inc. This article is protected by copyright. All rights reserved.
Head & Neck
recovery compared to conventional thyroid surgery [4, 5]. The aim of this non-randomized, observational, longitudinal study was to compare the quality of life (QOL) outcomes among patients treated with endoscopic thyroid lobectomy (ET) relative to those who received conventional open thyroid lobectomy (OT).
Material and methods
Patients From January 2010 to September 2011, 709 patients received unilateral thyroid lobectomy with or without central node dissection for papillary thyroid cancer (PTC) at Korea Cancer Center Hospital, and these patients were assessed for inclusion in the study. The indications for ET were as follows: differentiated microcarcinoma with low risk (age 15–45 years, no prior radiation, no distant metastases, no cervical lymph node metastases clinically, no extrathyroidal extension clinically, and a nonaggressive variant) and patents who didn’t want to leave neck scar. The indications for OT were as follows: differentiated microcarcinoma with low risk (age 15–45 years, no prior radiation, no distant metastases, no cervical lymph node metastases clinically, no extrathyroidal
3
John Wiley & Sons, Inc. This article is protected by copyright. All rights reserved.
Page 4 of 19
Page 5 of 19
Head & Neck
extension clinically, and a nonaggressive variant) but patents who didn’t want to perform endoscopic surgery regardless of scar formation. Patients were excluded if they (1) underwent total thyroidectomy, (2) neck dissection beyond central neck dissection. The following 3 different techniques were adapted for ET: the bilateral axillo-breast approach (BABA) with gas [8], the unilateral axillo-breast approach (UABA) without gas [9], and the UABA with gas [10].
Measures In the current study, QOL was measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 (EORTC QLQ-C30 ver. 3.0), which was developed in 1993 for the generic measurement of QOL in cancer patients [6]. It contains 30 cancer-specific questions that can be categorized into 1 global scale, 5 functional scales (physical, role, emotional, cognitive, and social), 3 symptom scales (fatigue, nausea and vomiting, and pain), and 6 single-item scales (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties) [7]. QOL was measured by using a validated Korean version of the EORTC QLQ-C30 version 3.0 4times in a row (preoperatively and at 1, 3, and 6 months post-operatively). All of items were scored and missing data were managed according to the EORTC
4
John Wiley & Sons, Inc. This article is protected by copyright. All rights reserved.
Head & Neck
Page 6 of 19
QLQ-C30 Scoring Manual [12]. A change over time of 0-4 points on the EORTC QLQ-C30 scales was not considered a clinically meaningful difference, whereas a mean change of 5-10 points was classified as a small change; 11-19 points was considered a moderate change; and 20 points or more was considered a large change[13]. All statistical analyses were performed by using the SPSS v12.0 for Windows software (SPSS Inc., Chicago, IL). To compare the 2 treatment groups on clinical and demographic variables, the independent t test and the ANOVA test were used for continuous data and the Fisher’s exact test or the chi-squared test was used for categorical data. Within each treatment group, differences in QOL from baseline (the preoperative score) were calculated using paired
t-test. Differences between the
groups in mean change scores were compared using ANOVA test.
Results
Patient characteristics The 401 of 709 eligible patients who underwent unilateral thyroid lobectomy were excluded from the analyses due to missing QOL questionnaires. Because they refused to
5
John Wiley & Sons, Inc. This article is protected by copyright. All rights reserved.
Page 7 of 19
Head & Neck
enroll in this study, they were not administered any of the questionnaires). These patients didn’t show significantly differences from the 308 participants enrolled in available clinical or demographic variables (data not shown). Among the 308 patients enrolled in this study, 233 underwent conventional open thyroid lobectomy(OT group) and 75 underwent endoscopic thyroid lobectomy (ET group). The mean ages of the patients were 42.2±8.6 years in the ET group and 52.1±9.3 years in the OT group(P
