Comparative Study of Robotic-Assisted Thyroidectomy versus Traditional Open Surgery in Thyroid Cancer Treatment

Academic Background

The incidence of thyroid cancer has been increasing annually, with differentiated thyroid carcinoma (DTC) accounting for over 90% of all thyroid cancer cases. Currently, the standard treatment for DTC includes surgical resection, radioactive iodine (RAI) therapy, and thyroid hormone suppression therapy. Surgical intervention remains the cornerstone of treatment, with traditional open thyroidectomy (OT) being the primary surgical approach. However, open surgery may lead to postoperative changes in neck appearance, particularly causing psychological distress for young female patients.

In recent years, robotic-assisted thyroidectomy (RT) has gained attention as a minimally invasive surgical approach. Robotic surgical systems offer advantages such as three-dimensional magnified vision and flexible robotic arm manipulation, enabling more precise surgical operations. However, the efficacy and safety of robotic surgery in thyroid cancer treatment remain controversial. This study aims to compare the efficacy and safety of RT versus traditional OT in thyroid cancer treatment by incorporating a dynamic risk assessment system using 131I whole-body scans (131I-WBS) and evaluating the therapeutic effects of RAI.

Source of the Paper

This paper was co-authored by Xiangquan Qin, Yufan Zhang, Jia Luo, and others from the Department of Breast and Thyroid Surgery and the Department of Nuclear Medicine at Southwest Hospital, Army Medical University. The paper was published online on September 12, 2024, in the International Journal of Surgery.

Research Process

Study Subjects and Sample Size

This retrospective cohort study included 2,349 patients who underwent total thyroidectomy followed by RAI therapy at Southwest Hospital between August 2017 and June 2023. Propensity score matching (PSM) was performed at a 1:3 ratio to match patients in the RT and OT groups, minimizing selection bias. Ultimately, 212 patients were included in the RT group and 575 in the OT group.

Study Design

1. Surgical Methods: The RT group underwent robotic-assisted thyroidectomy with super-meticulous capsular dissection (SMCD), while the OT group underwent traditional open surgery.
2. Postoperative Evaluation: The completeness of surgery and the therapeutic effects of RAI were assessed using the 131I-WBS dynamic risk assessment system. Evaluation metrics included the 3-hour iodine uptake rate, 99mTcO4- thyroid imaging, and postoperative dynamic risk scores.
3. Complications and Recurrence Rates: Postoperative complications (e.g., hypoparathyroidism, hoarseness) and local recurrence rates were recorded.

Data Analysis

Statistical analysis was performed using SPSS 27. Continuous variables were expressed as mean ± standard deviation, and categorical variables were expressed as frequencies and percentages. PSM was used to analyze differences in baseline characteristics between the two groups, and the dynamic risk assessment system was employed to stratify surgical outcomes.

Key Findings

Evaluation of Surgical Completeness

1. Iodine Uptake Rate and Thyroid Imaging: No significant differences were observed between the RT and OT groups in the 3-hour iodine uptake rate and 99mTcO4- thyroid imaging (P > 0.05), indicating similar completeness of thyroid tissue removal between the two surgical approaches.
2. Dynamic Risk Assessment: Dynamic risk assessment incorporating 131I-WBS showed no significant differences in postoperative and post-RAI dynamic risk scores between the RT and OT groups (P > 0.05). This suggests that RT is comparable to OT in terms of the thoroughness of tumor resection.

Complications and Recurrence Rates

1. Parathyroid Function: The rate of parathyroid gland transplantation was significantly lower in the RT group compared to the OT group (3.8% vs. 68.7%, P < 0.001). The incidence rates of transient and permanent hypoparathyroidism were also significantly lower in the RT group (P < 0.05).
2. Local Recurrence Rates: The local recurrence rates were 3.3% in the RT group and 4.7% in the OT group, with no significant difference (P > 0.05). No distant metastases were observed in either group.

Conclusions

By incorporating the 131I-WBS dynamic risk assessment system and evaluating the therapeutic effects of RAI, this study confirmed that robotic-assisted thyroidectomy (RT) is comparable to traditional open surgery (OT) in the treatment of thyroid cancer. Additionally, RT demonstrated significant advantages in preserving parathyroid function, effectively reducing the incidence of postoperative hypoparathyroidism.

Research Highlights

1. Innovative Assessment Method: This study is the first to integrate the 131I-WBS dynamic risk assessment system with RAI therapeutic efficacy evaluation, providing a novel approach for precise assessment of thyroid cancer surgical outcomes.
2. Surgical Safety: RT showed significant advantages in preserving parathyroid function, offering higher surgical safety for patients.
3. Long-Term Efficacy: RT demonstrated comparable tumor resection completeness and local recurrence rates to OT, confirming its long-term efficacy in thyroid cancer treatment.

Research Value

This study provides robust evidence supporting the application of robotic-assisted thyroidectomy in thyroid cancer treatment as a safe and effective minimally invasive surgical approach. The findings have significant implications for clinical decision-making, contributing to improved patient quality of life and treatment outcomes.

Additional Valuable Information

The limitations of this study include the potential lack of representativeness due to its single-center design and the exclusion of patients requiring lateral neck dissection. Future multicenter, large-sample prospective studies are needed to further validate the conclusions.