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  • Title: [Comparison of the efficacy of gasless robotic surgery through transaxillary apporach and open surgery for papillary thyroid carcinoma].
    Author: Liang FY, Han P, Lin PL, Lin XJ, Chen RH, Wang JY, Kong XW, Zou X, Deng LL, Huang XM.
    Journal: Zhonghua Yi Xue Za Zhi; 2024 Jul 09; 104(26):2409-2416. PubMed ID: 38978364.
    Abstract:
    Objective: To compare the efficacy of gasless robotic surgery through transaxillary approach and open surgery for papillary thyroid carcinoma (PTC). Methods: The data of patient undergoing robotic surgery through transaxillary approach and traditional open surgery for PTC at the Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from November 2016 to June 2023 were retrospectively analyzed. A 1∶1 propensity score matching (PSM) was performed to balance age, sex, extent of surgery, tumor size, capsule invasion, and multifocality. Surgical data, postoperative pathological data, complications, postoperative 2-month visual analog scale (VAS) scores for aesthetics, and follow-up data were compared between the two groups. Results: A total of 728 PTC patients were included. There were 339 patients in the robotic group, among which 262 were female (77.3%) and 77 were male (22.7%), with the age of [M (Q1, Q3)] 39 (32, 46) years and a body mass index (BMI) of 22.8 (20.7, 25.0) kg/m². Meanwhile, 389 patients were in the open group, among which 290 were female (74.6%) and 99 were male (25.4%), with the age of 47 (38, 55) years and a BMI of 23.2 (21.3, 25.5) kg/m2. Further analysis after PSM (there were 264 cases in both groups) showed that in the subtotal thyroidectomy and central neck dissection (LT+CCND) subgroup, the robotic group had longer operative time, higher blood loss, and greater drainage volume compared with the open group [100 (80, 130) min vs 60 (50, 80) min; 10 (10, 20) ml vs 10 (10, 20) ml; 103 (69, 145) ml vs 75 (57, 98) ml; all P<0.001], and the central lymph node metastasis rate was higher in the robotic group [45.6% (57/125) vs 31.8% (47/148), P=0.019]. In the total thyroidectomy and central neck dissection (TT+CCND) subgroup, the robotic group also had longer operative time, higher blood loss, and greater drainage volume compared with the open group [150 (110, 180) min vs 85 (75, 100) min; 20 (10, 20) ml vs 10 (10, 20) ml; 155 (107, 206) ml vs 90 (70, 120) ml; all P<0.001]. The incidence of chest skin numbness at 3 months postoperatively was higher in the robotic group compared with the open group (12.9% vs 0, P<0.001), while there were no statistically significant differences in other postoperative complications (all P>0.05). The VAS score at 2 months postoperatively was higher in the robotic group compared with the open group [9 (9, 9) vs 8 (7, 9), P<0.001]. Three cases of contralateral lobe recurrence occurred in the open group, while there were no case of recurrence in the robotic group. The 5-year overall survival rate was 100.0% in both the robotic and open groups, and there was no statistically significant difference in the 5-year disease-free survival rate between the robotic and open groups (100.0% vs 98.6%, P=0.068). Conclusion: Gasless robotic surgery through transaxillary approach for total thyroidectomy or lobectomy in the treatment of PTC is safe, feasible, and effective, with good cosmetic outcomes and comparable efficacy to traditional surgery. 目的： 比较免注气腋窝入路机器人甲状腺乳头状癌（PTC）手术与开放手术的疗效。 方法： 回顾性分析2016年11月至2023年6月中山大学孙逸仙纪念医院开展的免注气腋窝入路机器人（机器人组）及传统开放（开放组）PTC手术患者资料。通过倾向性评分匹配法（PSM）对年龄、性别、手术范围、肿瘤大小、被膜侵犯、多灶性情况进行1∶1匹配。比较两组患者手术相关资料、术后病理资料、并发症情况、术后2个月美观视觉模拟量表（VAS）评分及随访情况。 结果： 共纳入PTC患者728例。机器人组339例，女262例（77.3%），男77例（22.7%），年龄［M（Q1，Q3）］39（32，46）岁，体质指数（BMI）为22.8（20.7，25.0）kg/m2；开放组389例，女290例（74.6%），男99例（25.4%），年龄47（38，55）岁，BMI为23.2（21.3，25.5）kg/m2。PSM后两组均为264例，分析结果显示，在甲状腺腺叶切除+中央区清扫亚组中，机器人组的手术时间、出血量及引流量均多于开放组［100（80，130）min比60（50，80）min、10（10，20）ml比10（10，20）ml、103（69，145）ml比75（57，98）ml，均P<0.001］，中央区淋巴结转移率高于开放组［45.6%（57/125）比31.8%（47/148），P=0.019］。在甲状腺全切+中央区清扫亚组中，机器人组的手术时间、出血量及引流量均多于开放组［150（110，180）min比85（75，100）min、20（10，20）ml比10（10，20）ml、155（107，206）ml比90（70，120）ml，均P<0.001］。机器人组术后3个月胸部皮肤感觉麻木发生率高于开放组［12.9%（34/264）比0（0/264），P<0.001］，其余并发症发生情况差异无统计学意义（均P>0.05）。机器人组术后2个月美观VAS评分高于开放组［9（9，9）分比8（7，9）分，P<0.001］。开放组3例患者出现对侧腺叶复发，机器人组无复发病例，机器人组与开放组5年总生存率均为100.0%；机器人组5年无病生存率与开放组比较差异无统计学意义（100.0% 比98.6%，P=0.068）。 结论： 免注气腋窝入路机器人甲状腺全切除或腺叶切除治疗PTC均安全有效，术后美观效果好，疗效与传统手术相当。.
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