Upgraded hydrodissection and its safety enhancement in microwave ablation of papillary thyroid cancer: a comparative study

Abstract

Objectives

To study the efficacy and safety of an improved hydrodissection protocol based on the perithyroidal fascial space during microwave ablation for papillary thyroid carcinoma (PTC).

Methods

The data of 341 patients (94 men and 247 women, median age 41 years old, 25%–75% interquartile range 34–53 years old, nodule maximum diameter 0.2–1.9 cm) who underwent microwave ablation for PTC were retrospectively reviewed. Among them, 185 patients underwent traditional hydrodissection and served as a control group, and 156 patients underwent improved hydrodissection based on perithyroidal fascial spaces, constituting the improved group. Improvements in safety were analyzed by comparing complications between the two groups. The characteristics of hydrodissected spaces, complications, and follow-up results were recorded.

Results

Hydrodissection was successfully performed in all enrolled patients according to the protocol. The incidence of hoarseness caused by recurrent laryngeal nerve injury, the most common complication in thermal ablation of thyroid nodules, was significantly lower in the improved group than in the control group (1.9% vs. 8.1%, p = 0.021). The median hoarseness recovery time in the improved group was shorter than that in the control group (2 months vs. 3 months, p = 0.032). During follow-up, no local recurrence was encountered in either group. The tumor disappearance rate was not significantly different between the two groups (69.9% vs. 75.7%, p = 0.228).

Conclusions

Improved hydrodissection based on perithyroidal fascial spaces had better protective effects than traditional hydrodissection.

Keywords:

• Papillary thyroid cancer
• microwave ablation
• hydrodissection
• fascial space

Ethical approval

Our retrospective study was approved by the institutional review board of our hospital. Written informed consent was obtained from each patient before the ablation procedure. The patients consented to publishing their examination results and radiological images anonymously and the written informed consent for publication of their data were waived by ethics committee of China–Japan Friendship Hospital.

Statistics and biometry

One of the authors (Zhen-long Zhao) has significant statistical expertise.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was funded by National High Level Hospital Clinical Research Funding [grant 2022-NHLHCRF-PY-07] and the National Natural Science Foundation of China [grant 62176268].