Robotic versus open surgery for thyroidectomy and modified radical neck dissection in patients with papillary thyroid carcinoma with clinical lateral neck node metastasis (cN1b): Effectiveness and safety, oncological outcomes and long-term quality of life.
Authors: Zhou Yuqin , Ren Lin , Liang Yan , Yan Wenting , Chen Qiu , Su Xiaojun , Wan Andi , Deng Jun , Zhong Ling , Liu Junlan , Zhao Tingting , Tang Peng , Chen Li , Fan Linjun , Qi Xiaowei , Zhang Yi 
Published: June 2024

e18069

Background: Open thyroidectomy (TT) with modified radical neck dissection (MRND) is used for papillary thyroid carcinoma (PTC) with clinical lateral neck node metastasis (cN1b). robotic surgery for TT with MRND is being carried out and some studies have confirmed its efficacy. However, such studies are limited by indicators and samples. The study aimed to compare robotic TT with MRND with open surgery in patients with cN1b PTC in efficacy, safety, oncological outcomes and quality of life. Methods: In this retrospective cohort study, 2027 patients receiving MRND between January 2016 and December 2021 were enrolled. After exclusion, 1153 PTC patients met the inclusion criteria, in which 168 (14.57%) underwent robotic surgery and 985 (85.43%) underwent open surgery. Propensity score matching (PSM) at a 1:2 ratio was performed to minimize bias. We compared the efficacy, safety and oncological outcomes before and after PSM, we also evaluated the quality of life of patients after PSM. Results: Before and after PSM, the number of central lymph nodes ( p<0.001) and lateral cervical lymph nodes(p<0.001),and the number of positive lateral cervical lymph nodes(before PSM p=0.037, after PSM, p=0.018 ) in the robotic group were lower than those open group. RAI-avid lesion in postoperative 131 RAI scan showed no difference between two groups and showed similar complication rates before or after PSM, including chyle leakage, infection, and permanent hypoparathyroidism. Because the rate of parathyroid misresection and the number of transplanted parathyroid glands were improved, robotic was superior to open group in preventing transient hypoparathyroidism. The patients were followed up for mean 50.57 months in the robotic group and 51.78 months in the open group. There was no difference between two groups in recurrence rate (before PSM: 5/168 [2.98%] vs 32/985 [3.25%], p>0.99; after PSM: 5/168 [2.98%] vs 15/336 [4.46%], p=0.572) and distant metastasis rate (before PSM: 1/168 [0.60%] vs 3/985 [0.30%], p>0.99; after PSM: 1/168 [0.60%] vs 1/336 [0.30%], p>0.99). We conducted a quality of life survey in 504 patients after PSM and collected 317 copies, of which 316 were valid. Compared with the open group, the robotic group had similar performance in health-related quality of life(HR-QOL) and the QOL issues specific to thyroid cancer, including subjective voice, dysphagia, neck and shoulder disability. The scores of scar showed a significant difference in the appearance and psychosocial impact of scars between two groups (p<0.001). Conclusions: Robotic surgery can provide more meticulous operation to reduce postoperative complications and better quality of life, especially scars, there is no significant difference in oncologic outcomes between two groups.