Zhonghua wai ke za zhi [Chinese journal of surgery]最新文献

{"title":"[Living-donor intestinal transplantation].","authors":"G S Wu,&nbsp;Z X Liu,&nbsp;L Zhao,&nbsp;T B Liang","doi":"10.3760/cma.j.cn112139-20230223-00080","DOIUrl":"10.3760/cma.j.cn112139-20230223-00080","url":null,"abstract":"<p><p>Due to advances in surgical techniques, perioperative care, and new immunosuppressive agents, intestinal transplantation has become a valid therapeutic choice for chronic intestinal failure. Intestinal transplantation has been performed most commonly using deceased donation, while less than 2% of which have been from living donation. Living donor intestinal transplantation obtaining a segmental intestinal graft, usually from close relatives. Preliminary results show that acute/chronic rejection rates, postoperative opportunistic infections, and graft versus host disease are significantly reduced after living donor intestinal transplantation, contributing to improved graft and patient survivals. Due to a severe shortage of organ donation, especially in children, living donor intestinal transplantation has increasingly become an important treatment option for patients with chronic intestinal failure in China.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 10","pages":"850-855"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Establishment of the quality assessment system for pancreatic cancer surgery: from \"single complication assessment\" to \"textbook outcome\"].","authors":"L Y Zhu, S W Guo, G Jin","doi":"10.3760/cma.j.cn112139-20230308-00097","DOIUrl":"10.3760/cma.j.cn112139-20230308-00097","url":null,"abstract":"<p><p>With the development of neoadjuvant therapy and a multidisciplinary team, the treatment of pancreatic cancer has gradually expanded from \"resection\" to \"cure\".\"Curative resection\" as the core part of the integrated treatment model for patients, its quality directly determines the short-term outcome and affects the long-term prognosis. Previously, the \"single complication assessment\" model was used to measure the quality of pancreatic cancer surgery. However, the incidence of any specific complication cannot cover the entire surgical procedure, making it difficult to quantify and standardize the interpretation of the outcomes. Recently, the concept of textbook outcome, a comprehensive indicator, has gained popularity in surgical research. Textbook outcome includes multiple complication parameters and reflects optimal surgical outcomes in an \"all or none\" approach. Implementing a quality improvement program that focuses on textbook outcome will increase the overall standard of complex surgery, ultimately advancing the surgical care of pancreatic cancer in the future. In this article, the latest advances in relevant research are analyzed to provide a brief overview of the textbook outcome of pancreatic cancer.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 10","pages":"833-838"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10185750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The technical difficulties and surgical key points of laparoscopic radical resection for perhilar cholangiocarcinoma].","authors":"Q Li,&nbsp;J D Li","doi":"10.3760/cma.j.cn112139-20230125-00035","DOIUrl":"10.3760/cma.j.cn112139-20230125-00035","url":null,"abstract":"<p><p>With the continuous accumulation of laparoscopic radical resection for perihilar cholangiocarcinoma(PHC), the safety and feasibility have been confirmed, and some studies have shown that considering the comparable long-term prognosis and short-term outcomes of laparoscopic surgery and open surgery, laparoscopic surgery could be a technically feasible surgical method for PHC patients of all Bismuth-Corlette types. However, laparoscopic radical resection for PHC is still challenging and controversial due to the complex operation process, surgery-related complications and quality control in different centers. How to solve some key points and difficulties in the operation process, reduce surgical complications, improve the survival prognosis of patients, to make the operation widely popularized and applied are urgent problems for hepatobiliary surgeons. In this paper, some technical difficulties and key points of laparoscopic radical resection for PHC are discussed with the author's team surgical experience and related literature.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 10","pages":"845-849"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Application of augmented reality navigation combined with indocyanine green fluorescence imaging technology in the accurate guidance of laparoscopic anatomical segment 8 liver resection].","authors":"H S Tao,&nbsp;Z X Wang,&nbsp;B H Li,&nbsp;K W Guo,&nbsp;Y L Qian,&nbsp;C H Fang,&nbsp;J Yang","doi":"10.3760/cma.j.cn112139-20230330-00129","DOIUrl":"10.3760/cma.j.cn112139-20230330-00129","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the application value of augmented reality navigation combined with indocyanine green(ICG) fluorescence imaging technology in laparoscopic anatomical segment 8 liver resection. <b>Methods:</b> Clinical and pathological data from 8 patients with hepatocellular carcinoma located in segment 8 of the liver admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from October 2021 to October 2022 were collected restrospectively. Among them,there were 5 males and 3 females,aged between 40 and 72 years. During the operation,the self-developed laparoscopic augmented reality surgical navigation system was used to integrate the three-dimensional liver model with the laparoscopic scene,and ICG fluorescence imaging technology was used to guide the anatomical liver resection of segment 8. The predicted liver resection volume and actual liver resection volume,related surgical indicators and postoperative complications were analyzed. <b>Results:</b> Among the 8 patients, 4 underwent laparoscopic anatomical segment 8 liver resection,1 underwent laparoscopic anatomical ventral subsegment of segment 8 liver resection,2 underwent laparoscopic anatomical ventral subsegment combined with medial subsegment of segment 8 liver resection, and 1 underwent laparoscopic anatomical dorsal subsegment of segment 8 liver resection. All operations were completed under the guidance of augmented reality navigation combined with ICG fluorescence imaging,without conversion to open surgery. The operation time was (276.3±54.8)minutes(range:200 to 360 minutes). Intraoperative blood loss was (75.0±35.4)ml(range:50 to 150 ml). No blood transfusion was performed during the operation. The length of postoperative hospital stay was (7.6±0.8)days(range:7 to 9 days). There were no deaths or postoperative complications such as bleeding or biliary fistula during the perioperative period. <b>Conclusion:</b> Augmented reality navigation combined with ICG fluorescence imaging technology can guide the implementation of laparoscopic anatomical segment 8 liver resection.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 10","pages":"880-886"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Distal pancreatectomy with celiac axis resection for pancreatic body cancer: a single center review of 89 consecutive cases].","authors":"X M Huang, K Zhang, J Yin, P F Wu, B B Cai, Z P Lu, M Tu, J M Chen, F Guo, C H Xi, J S Wei, J L Wu, W T Gao, C C Dai, Y Miao, K R Jiang","doi":"10.3760/cma.j.cn112139-20230327-00123","DOIUrl":"10.3760/cma.j.cn112139-20230327-00123","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical efficacy of distal pancreatectomy with celiac axis resection(DP-CAR). <b>Methods:</b> A total of 89 consecutive patients (50 males and 39 females) who were diagnosed with pancreatic body cancer and underwent DP-CAR in Pancreas Center,First Affiliated Hospital of Nanjing Medical University between September 2013 and June 2022 were retrospectively reviewed. There were 50 males and 39 females,with age(<i>M</i>(IQR)) of 63(12) years(range:43 to 81 years). Perioperative parameters,pathology results and follow-up data of these patients were analyzed,<i>χ</i>² or Fisher's test for categorical data while the Wilcoxon test for quantitative data. Survival results were estimated by the Kaplan-Meier survival method. <b>Results:</b> Among 89 cases,cases combined with portal vein-superior mesenteric vein or organ resection accounted for 22.5% (20/89) and 42.7% (38/89),respectively. The operative time,blood loss and postoperative hospital stay were 270 (110) minutes,300 (300) ml and 13 (10) days,respectively. The overall morbidity rate was 67.4% (60/89) while the major morbidity was 11.2% (10/89). The increase rate in transient liver enzymes was 42.7% (38/89),3.4% (3/89) for liver failure,53.9% (48/89) for clinically relevant postoperative pancreatic fistula,1.1% (1/89) for bile leak,3.4% (3/89) for chylous leak of grade B and C,11.2% (10/89) for abdominal infection,9.0% (8/89) for postoperative hemorrhage of grade B and C,4.5% (4/89) for delayed gastric emptying,6.7% (6/89) for deep vein thrombosis,3.4% (3/89) for reoperation,4.5% (4/89)for hospital mortality,7.9% (7/89) for 90-day mortality. The pathological type was pancreatic cancer for all 89 cases and pancreatic ductal adenocarcinoma made up 92.1% (82/89). The tumor size was 4.8(2.0) cm, ranging from 1.5 to 12.0 cm. The number of lymph nodes harvested was 14 (13)(range:2 to 33),with a positive lymph node rate of 13.0% (24.0%). The resection R0 rate was 30.0% (24/80) and the R1 (<1 mm) rate was 58.8% (47/80). The median overall survival time was 21.3 months (95%<i>CI</i>: 15.6 to 24.3) and the median disease-free survival time was 19.1 months (95%<i>CI</i>: 11.7 to 25.1). The overall survival at 1-year and 2-year were 69.60% and 39.52%. The median survival time of 58 patients with adjuvant chemotherapy was 24.3 months (95%<i>CI</i>: 17.8 to 32.3) while that of 13 patients without any kind of adjuvant therapy was 8.4 months (95%<i>CI</i>: 7.3 to 22.3). Seven patients accepted neoadjuvant chemotherapy and there was no significant morbidity among them,with a resection rate of R0 of 5/7. <b>Conclusion:</b> DP-CAR is safe and feasible for selective cases,which could be more valuable in improving long-term survival when combined with (neo) adjuvant therapy.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 10","pages":"894-900"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Advances in combination strategies with oncolytic virotherapy].","authors":"Z L Zhai,&nbsp;Y N Shen,&nbsp;X L Bai,&nbsp;T B Liang","doi":"10.3760/cma.j.cn112139-20230514-00201","DOIUrl":"10.3760/cma.j.cn112139-20230514-00201","url":null,"abstract":"<p><p>Compared with conventional treatments, oncolytic virotherapy has the advantages of enhanced cytotoxicity, improved targeting, and minimal side effects. However, its efficacy is not as good as expected for the single drug treatment. The purpose of synergistic effect is one of the development directions of existing oncolytic virus therapy. In this paper, through a systematic review of the current preclinical and clinical trials progress of oncolytic virus combination therapy, the combined treatment strategies of oncolytic virus and immune checkpoint inhibitors, chemotherapy, targeted therapy,and cell therapy are reviewed to provide reference for further clinical application.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 10","pages":"923-928"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of clinicopathological characteristics and prognosis of papillary thyroid carcinoma in children and adolescents at different ages].","authors":"Z H Wang,&nbsp;H Zhang","doi":"10.3760/cma.j.cn112139-20230405-00144","DOIUrl":"10.3760/cma.j.cn112139-20230405-00144","url":null,"abstract":"<p><p><b>Objectives:</b> To examine the age cut-off point for poor clinicopathological characteristics and prognosis of differentiated thyroid carcinoma (DTC) in children and adolescents. <b>Methods:</b> The clinicopathological features of 74 patients with DTC aged 18 years and younger who underwent surgery in the Department of Thyroid Surgery, the First Hospital of China Medical University from January 2011 to December 2020 were retrospectively analyzed. There were 20 males and 54 females, aged (<i>M</i>(IQR)) 16 (4) years (range: 8 to 18 years). Firstly, the cut-off point of age affecting prognosis was determined according to the receiver operator characteristic curve, the patients included in the study were grouped according to the age cut-off, and then the univariate and multivariate analysis for prognostic factors were performed using the Cox risk proportional regression model. The Kaplan-Meier survival curve was used to verify the factors affecting the prognosis and analyzed the possible mechanisms by bioinformatics. <b>Results:</b> The cut-off value of age was 15 years. Age ≤15 years was the only prognostic factor for recurrence (<i>HR</i>=4.427, 95%<i>CI</i>: 1.236 to 15.859, <i>P</i>=0.022). The number of metastatic cervical lymph nodes was higher in patients aged ≤15 years, and the 10-year recurrence-free survival rate was much lower than in patients aged >15 years (50.4% <i>vs.</i> 84.1%, <i>P</i>=0.018). Gene enrichment analysis and differential gene identification showed that differential genes between ≤15 years old group and>15 years old group were closely related to the transforming growth factor-β signaling pathway and some metabolism-related signaling pathways. <b>Conclusions:</b> Age ≤15 years is the only prognostic factor for the prognosis of DTC in children and adolescents. Age ≤15 years had more cervical lymph node metastases and a worse prognosis. For younger DTC patients, more active treatment and a stricter postoperative management strategy should be adopted.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"795-800"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The value of transanal multipoint full-layer puncture biopsy in determining the response degree of rectal cancer following neoadjuvant therapy: a prospective multicenter study].","authors":"J G Han,&nbsp;L T Sun,&nbsp;Z W Zhai,&nbsp;P D Xia,&nbsp;H Hu,&nbsp;D Zhang,&nbsp;C Q Jiang,&nbsp;B C Zhao,&nbsp;H Qu,&nbsp;Q Qian,&nbsp;Y Dai,&nbsp;H W Yao,&nbsp;Z J Wang","doi":"10.3760/cma.j.cn112139-20230417-00170","DOIUrl":"10.3760/cma.j.cn112139-20230417-00170","url":null,"abstract":"<p><p><b>Objective:</b> To verify the feasibility and accuracy of the transanal multipoint full-layer puncture biopsy (TMFP) technique in determining the residual status of cancer foci after neoadjuvant therapy (nCRT) in rectal cancer. <b>Methods:</b> Between April 2020 and November 2022, a total of 78 patients from the Beijing Chaoyang Hospital of Capital Medical University, the Beijing Friendship Hospital of Capital Medical University, the Qilu Hospital of Shandong University, the Zhongnan Hospital of Wuhan University with advanced rectal cancer received TMFP after nCRT participated in this prospective multicenter trial. There were 53 males and 25 females, aged (<i>M</i>(IQR)) 61 (13) years (range: 35 to 77 years). The tumor distance from the anal verge was 5 (3) cm (range: 2 to 10 cm). The waiting time between nCRT and TMFP was 73 (26) days (range: 33 to 330 days). 13-point transanal puncture was performed with a 16 G tissue biopsy needle with the residual lesion as the center. The specimens were submitted for independent examination and the complications of the puncture were recorded. The consistency of TMFP and radical operation specimen was compared. The consistency of TMPF with clinical remission rates for the diagnosis of complete pathological remission was compared by sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Statistical analysis between groups was performed using the <i>χ</i>² analysis, and a paired <i>χ</i>² test was used to compare diagnostic validity. <b>Results:</b> Before TMFP, clinical complete response (cCR) was evaluated in 27 cases. Thirty-six cases received <i>in vivo</i> puncture, the number of punctures in each patient was 13 (8) (range: 4 to 20), 24 cases of tumor residue were found in the puncture specimens. The sensitivity to judgment (100% <i>vs.</i> 60%, <i>χ</i>²=17.500, <i>P</i><0.01) and accuracy (88.5% <i>vs.</i> 74.4%, <i>χ</i>²=5.125, <i>P</i>=0.024) of TMFP for the pathologic complete response (pCR) were significantly higher than those of cCR. Implement TMFP based on cCR judgment, the accuracy increased from 74.4% to 92.6% (<i>χ</i>²=4.026, <i>P=</i>0.045). The accuracy of the <i>in vivo</i> puncture was 94.4%, which was 83.3% of the <i>in vitro</i> puncture (<i>χ</i>²=1.382, <i>P=</i>0.240). Overall, the accuracy of TMFP improved gradually with an increasing number of cases (<i>χ</i>²=7.112, <i>P=</i>0.029). <b>Conclusion:</b> TMFP is safe and feasible, which improves the sensitivity and accuracy of rectal cancer pCR determination after nCRT, provides a pathological basis for cCR determination, and contributes to the safe development of the watch and wait policy.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"768-774"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evaluation strategy of complete response after neoadjuvant therapy for rectal cancer].","authors":"J G Han,&nbsp;Z J Wang","doi":"10.3760/cma.j.cn112139-20230417-00171","DOIUrl":"10.3760/cma.j.cn112139-20230417-00171","url":null,"abstract":"<p><p>Currently, the standard of clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) for local advanced rectal cancer generally lacks pathological examination, the cCR judged by the current standard is still far from the real pathological complete response. After nCRT, due to the presence of tissue edema and fibrosis, MRI is highly uncertain in determining the staging of local lesions. The precision of colonoscopy biopsy is generally low because residual cancer foci exist primarily in the muscular layer, which limits the determination of cCR by colonoscopy biopsy. Local excision through the anus can resect the whole intestinal wall tissue, which is relatively accurate and close to the real state of remission of the lesion, but there are many problems, such as affecting anal function, high rate of complications, and increased difficulty of following radical surgery. Based on the present diagnosis of cCR, the authors put forward the concept of modified cCR (m-cCR) which combined with the pathological standard of transanal multipoint full-layer puncture biopsy. It is possible to improve the accuracy of cCR, and improve the safety of cCR patients who receive wait-and-watch therapy without increasing complications or affecting anal function. The exact conclusion needs to be confirmed by further studies.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"738-743"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparison of clinical effects of endoscopic thyroidectomy using the modified gasless transsubclavian approach and traditional open surgery for cN0 unilateral papillary thyroid carcinoma].","authors":"X M Zhu,&nbsp;S Xue,&nbsp;H W Xue,&nbsp;Q Y Lu,&nbsp;G Chen,&nbsp;P S Wang","doi":"10.3760/cma.j.cn112139-20230208-00056","DOIUrl":"10.3760/cma.j.cn112139-20230208-00056","url":null,"abstract":"<p><p><b>Objective:</b> To compare the clinical effects of endoscopic thyroidectomy using a modified gasless transsubclavian approach and the traditional neck approach for unilateral papillary thyroid carcinoma (cN0). <b>Methods:</b> The clinical data of 135 patients with cN0 papillary thyroid carcinoma who underwent unilateral thyroidectomy in the Department of Thyroid Surgery, the First Hospital of Jilin University from October 2020 to November 2022 were retrospectively analyzed. There were 37 males and 98 females, aging (43.2±8.8) years (range: 21 to 59 years). There were 51 cases using the modified gasless transsubclavian approach (TS group) and 84 cases using the traditional neck approach (TN group). Comparative analyses were performed between the operative results of the 2 groups by <i>t</i>-test, Wilcoxon rank sum test, and <i>χ</i>² test. <b>Results:</b> All endoscopic operations were successfully completed without conversion to the traditional neck approach. Compared to the TN group, the TS group had a longer operation time (<i>M</i>(IQR)) (73.5 (22.5) minutes <i>vs.</i> 90.0 (30.0) minutes, <i>Z</i>=-5.831, <i>P</i><0.01), more postoperative drainage (60 (25) ml <i>vs.</i> 95 (45) ml, <i>Z</i>=-6.275, <i>P</i><0.01), higher hospitalization costs (22 687 (3 488) yuan <i>vs.</i> 26 652 (2 431) yuan, <i>Z</i>=-6.944, <i>P</i><0.01), and a higher rate of parathyroid autotransplantation (15.5% (13/84) <i>vs.</i> 60.8% (31/51), <i>χ</i>²=29.651, <i>P</i><0.01). There was no significant difference in the total exposure rate of the central compartment, postoperative hospitalization time, the number of dissected lymph nodes, the number of metastatic lymph nodes, C-reactive protein ratio before and after operation, and preoperative and postoperative parathyroid hormone (all <i>P</i>>0.05). <b>Conclusion:</b> Endoscopic thyroidectomy using the modified gasless transsubclavian approach is safe for cN0 papillary thyroid carcinoma, with longer operating time, more postoperative drainage, higher hospitalization costs, and more difficulty in preserving the inferior parathyroid gland in situ compared to traditional open surgery.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"807-811"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}