Young Jun Chai1, Hyunsuk Suh2, Jung-Woo Woo3, Hyeong Won Yu3, Ra-Yeong Song3, Hyungju Kwon3, Su-jin Kim3, June Young Choi4, Seong Ho Yoo5, Kyu Eun Lee3. 1Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 2Department of Surgery, Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, USA, 3Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea, 4Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, Korea, 5Seoul National University Hospital, Biomedical Research Institute and Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
The safety of robotic thyroidectomy (RT) has been well established for an early stage differentiated thyroid carcinoma and it is generally indicated for the tumors ≤ 2cm. However, RTs have been selectively performed for the tumors larger than 2cm when patients request or the preoperative diagnosis of malignancy is uncertain. In this study, we evaluated the safety of RT by comparing the surgical outcomes of RT and conventional open thyroidectomy (OT)
The medical records were retrospectively reviewed for the patients who underwent total thyroidectomy or hemithyroidectomy accompanied by completion thyroidectomy due to the differentiated thyroid carcinoma from 2009 to 2014. The outcomes of surgery and radioactive iodine treatment were compared between the patients who underwent RT and OT. As an RT procedure, bilateral axillo-breast approach (BABA) was used, and operations were conducted by experienced endocrine surgeons.
Totally 86 patients were eligible (21 BABA RT, 65 OT). Mean age was 30.8 for BABA RT group, and 51.6 for the OT group (p<0.001). The mean tumor size were equal for both groups (2.8 ± 0.6 cm, p=0.991). Operation time was longer in the BABA RT group than in the OT group (165.1 ± 43.9 vs. 93.5 ± 30.8 min, p<0.001). Vocal cord paralysis rate based on laryngoscopy evaluation were comparable for BABA and OT (transient, BABA RT; 19.0% vs. OT; 9.2%, p=0.250, permanent, 0% vs. 1.5%, p=1.000). There was no significant difference in the postoperative hypoparathyroidism rate (transient, BABA RT 19.0% vs. OT; 33.8%, p=0.199, permanent, 0% for both), and in the number of retrieved central lymph nodes (BABA RT; 2.1 ± 3.3 vs. OT; 1.5 ± 1.9, p=0.757). At initial radioactive iodine treatment, the proportion of the patients with stimulated thyroglobulin (Tg) level of < 1.0 ng/ml in the absence of anti-Tg antibody was 53.8% (7/13) for BABA RT group and 65.3% (32/49) for OT group (p=0.525). Neither group had recurrences during the median follow up period of 36.9 months for BABA and 25.5 months for OT.
BABA RT is a safe and oncologically sound treatment option for 2-4cm differentiated thyroid carcinoma for a selected group of patients. Its role in advanced thyroid carcinoma management should be continually evaluated as the RT experience and technology evolve.