Improvements in Thyroid Tumor Surgery and the Prognosis, Diagnosis, Recurrence and Metastasis of Patients

Study Purpose: Background and Significance Trans-axillary and trans-breast endoscopic thyroid surgery is currently the most widely used and recognized minimally invasive cosmetic thyroid surgery method. However, due to its inherent characteristics, this approach still has certain limitations that require further improvement. For example, there have been no studies reporting the short-term and long-term advantages of not suturing the cervical white line during trans-breast endoscopic thyroid surgery. Through theoretical analysis, it is suggested that not suturing the cervical white line during endoscopic thyroid surgery might be safe and feasible in terms of reducing operation time, postoperative pain, and incision complications, but this needs to be further verified.

The mechanisms underlying the occurrence, progression, metastasis, and recurrence of thyroid cancer are still not completely understood, necessitating further basic and clinically relevant research using clinical specimens.

Combining the current research progress domestically and internationally, the purpose of this study is to explore the clinical outcomes of improved surgical methods, such as not suturing the cervical white line during trans-axillary and trans-breast endoscopic thyroidectomy. In addition, the study aims to collect normal thyroid tissue, benign and malignant thyroid tumors, and lymph nodes to further elucidate the mechanisms related to the occurrence, progression, metastasis, and recurrence of thyroid cancer.

Study Procedure Before you are enrolled in the study, the doctor will conduct a detailed inquiry and record your medical history. Preoperative evaluations will include thyroid and lymph node ultrasound, neck CT, thyroid function tests, and fine-needle aspiration biopsy. If you meet the inclusion and exclusion criteria, you can voluntarily choose to participate in this study and sign an informed consent form. If you agree to participate in this study, you will be assigned a number, and a research file will be created.

This study will be conducted at the Second Affiliated Hospital of Xi'an Jiaotong University, with an estimated 200 voluntary participants. The research will involve collecting medical information data generated during routine clinical diagnosis and treatment, pathological reports, and tissue specimens from the thyroid, thyroid tumors, and lymph nodes obtained during surgery.

• Suturing the cervical linea alba during endoscopic thyroid surgery. (Procedure): Suturing the cervical linea alba during endoscopic thyroid surgery.
• Performing transcriptome sequencing (Genetic): Performing transcriptome sequencing

Primary outcomes

• Postoperative neck edema Incidence rate [Within one week post-surgery]: Postoperative neck edema Incidence rate
• Postoperative short-term pain [Within one week post-surgery]: Record the patient's perception of wound pain on postoperative days 1, 3, and 5 using the Numerical Rating Scale (NRS), which ranges from 0 (no pain) to 10 (worst pain), for quantification.
• Thyroid Papillary carcinoma tissue mRNA expression profile [Within one month after the transcriptome sequencing.]: After extracting total RNA from tissue, it is purified and a cDNA library is constructed. Following library quality control, sequencing is conducted on the Illumina NovaSeq 6000 platform using the PE150 mode to obtain tissue mRNA expression data.
• Thyroid papillary carcinoma metastatic lymph node mRNA expression profile [Within one month after the transcriptome sequencing.]: After extracting total RNA from tissue, it is purified and a cDNA library is constructed. Following library quality control, sequencing is conducted on the Illumina NovaSeq 6000 platform using the PE150 mode to obtain tissue mRNA expression data.

Sex: All, ages: 18 Years to 75 Years

Inclusion Criteria:

1. Perform transthoracic endoscopic thyroidectomy via breast approach;
2. Postoperative pathology confirms benign or malignant thyroid tumors;
3. Preoperative thyroid ultrasound or cervical CT suggests no extrathyroidal invasion or distant metastasis of the tumor;
4. No contraindications for general anesthesia;
5. Patients with cosmetic requirements.

Exclusion Criteria:

1. Underwent transthoracic endoscopic thyroidectomy;
2. Postoperative pathology confirmed as benign or malignant thyroid tumors;
3. Preoperative thyroid ultrasound or neck CT suggested no extraglandular invasion or distant metastasis of the tumor;
4. No contraindications to general anesthesia;
5. Patients with cosmetic demands.

• Zhidong Wang, Principal investigator, Xi'an Jiaotong University Second Affiliated Hospital