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Erschienen in: World Journal of Surgery 2/2019

21.09.2018 | Original Scientific Report

A Propensity Score-matched Comparison Study of Surgical Outcomes in Patients with Differentiated Thyroid Cancer After Robotic Versus Open Total Thyroidectomy

verfasst von: Dong Sik Bae, Do Hoon Koo

Erschienen in: World Journal of Surgery | Ausgabe 2/2019

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Abstract

Introduction

The aim of this study, from a surgical, oncological, and functional perspective, was to identify whether bilateral axillo-breast approach robotic total thyroidectomy (RTT) for differentiated thyroid cancer (DTC) has different surgical outcomes compared to open total thyroidectomy (OTT).

Methods

Initially, 796 patients who underwent total thyroidectomy were primarily reviewed and 178 who were ineligible for analysis were excluded. Propensity score matching analysis adjusted for clinicopathological characteristics (sex, age, body mass index, extent of central node dissection, tumor size, extrathyroidal extension, and thyroiditis) was conducted, with 246 patients in the OTT group matched with 123 patients in the RTT group.

Results

There were no significant differences in surgical outcomes in terms of surgical safety and oncological safety between the OTT and RTT groups, except in mean operation times (123.51 ± 32.63 vs. 198.39 ± 37.93 min, respectively; P < 0.001). However, the median parathyroid and laryngeal function recovery times were shorter in the RTT group than in the OTT group [88 ± 33.09 (95% CI: 23.148–152.852) vs. 100 ± 16.20 (95% CI: 68.242–131.768) days; P = 0.044 and 87 ± 32.40 (95% CI: 23.489–150.511) vs. 118 ± 49.50 (95% CI: 20.985–215.015) days; P = 0.002].

Conclusions

The recovery times of laryngeal and parathyroid function were significantly shorter in RTT patients than in OTT patients for DTC. To verify a definitive conclusion about the superiority of robotic total thyroidectomy in terms of parathyroid and laryngeal function recovery, further studies may be necessary.
Literatur
2.
Zurück zum Zitat Linos D (2011) Minimally invasive thyroidectomy: a comprehensive appraisal of existing techniques. Surgery 150:17–24CrossRefPubMed Linos D (2011) Minimally invasive thyroidectomy: a comprehensive appraisal of existing techniques. Surgery 150:17–24CrossRefPubMed
3.
Zurück zum Zitat Bellantone R, Lombardi CP, Raffaelli M et al (1999) Minimally invasive, totally gasless video-assisted thyroid lobectomy. Am J Surg 177:342–343CrossRefPubMed Bellantone R, Lombardi CP, Raffaelli M et al (1999) Minimally invasive, totally gasless video-assisted thyroid lobectomy. Am J Surg 177:342–343CrossRefPubMed
4.
Zurück zum Zitat Koo DH, Kim DM, Choi JY et al (2015) In-depth survey of scarring and distress in patients undergoing bilateral axillo-breast approach robotic thyroidectomy or conventional open thyroidectomy. Surg Laparosc Endosc Percutan Tech 25:436–439CrossRefPubMed Koo DH, Kim DM, Choi JY et al (2015) In-depth survey of scarring and distress in patients undergoing bilateral axillo-breast approach robotic thyroidectomy or conventional open thyroidectomy. Surg Laparosc Endosc Percutan Tech 25:436–439CrossRefPubMed
6.
Zurück zum Zitat Lee KE, Koo DH, S-j Kim et al (2010) Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery 148:1207–1213CrossRefPubMed Lee KE, Koo DH, S-j Kim et al (2010) Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery 148:1207–1213CrossRefPubMed
7.
Zurück zum Zitat Kang S-W, Jeong JJ, Yun J-S et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399CrossRefPubMed Kang S-W, Jeong JJ, Yun J-S et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399CrossRefPubMed
8.
Zurück zum Zitat Lang BHH, Wong CK, Tsang JS et al (2015) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope 125:509–518CrossRefPubMed Lang BHH, Wong CK, Tsang JS et al (2015) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope 125:509–518CrossRefPubMed
9.
Zurück zum Zitat Lee J, Nah KY, Kim RM et al (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194CrossRefPubMed Lee J, Nah KY, Kim RM et al (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194CrossRefPubMed
10.
Zurück zum Zitat Tae K, Kim KY, Yun BR et al (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26:1871–1877CrossRefPubMed Tae K, Kim KY, Yun BR et al (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26:1871–1877CrossRefPubMed
11.
Zurück zum Zitat Lee KE, Choi JY, Youn YK (2011) Bilateral axillo-breast approach robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:230–236CrossRefPubMed Lee KE, Choi JY, Youn YK (2011) Bilateral axillo-breast approach robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:230–236CrossRefPubMed
12.
Zurück zum Zitat Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133CrossRefPubMedPubMedCentral Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Tuttle RM, Tala H, Shah J et al (2010) Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 20:1341–1349CrossRefPubMedPubMedCentral Tuttle RM, Tala H, Shah J et al (2010) Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 20:1341–1349CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Yi KH (2016) The revised 2016 Korean Thyroid Association guidelines for thyroid nodules and cancers: differences from the 2015 American Thyroid Association guidelines. Endocrinol Metab 31:373–378CrossRef Yi KH (2016) The revised 2016 Korean Thyroid Association guidelines for thyroid nodules and cancers: differences from the 2015 American Thyroid Association guidelines. Endocrinol Metab 31:373–378CrossRef
15.
Zurück zum Zitat Perrier ND, Randolph GW, Inabnet WB et al (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20:1327–1332CrossRefPubMed Perrier ND, Randolph GW, Inabnet WB et al (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20:1327–1332CrossRefPubMed
16.
Zurück zum Zitat Stukel TA, Fisher ES, Wennberg DE et al (2007) Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA 297:278–285CrossRefPubMedPubMedCentral Stukel TA, Fisher ES, Wennberg DE et al (2007) Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA 297:278–285CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Inabnet WB III (2012) Robotic thyroidectomy: must we drive a luxury sedan to arrive at our destination safely? Thyroid 22:988–990CrossRefPubMed Inabnet WB III (2012) Robotic thyroidectomy: must we drive a luxury sedan to arrive at our destination safely? Thyroid 22:988–990CrossRefPubMed
19.
Zurück zum Zitat Lee KE, Rao J, Youn Y-K (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19:e71–e75CrossRefPubMed Lee KE, Rao J, Youn Y-K (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19:e71–e75CrossRefPubMed
20.
Zurück zum Zitat Lee KE, Koo DH, Im HJ et al (2011) Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: comparison with conventional open thyroidectomy after propensity score matching. Surgery 150:1266–1274CrossRefPubMed Lee KE, Koo DH, Im HJ et al (2011) Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: comparison with conventional open thyroidectomy after propensity score matching. Surgery 150:1266–1274CrossRefPubMed
21.
Zurück zum Zitat Kim BS, Kang KH, Kang H et al (2014) Central neck dissection using a bilateral axillo-breast approach for robotic thyroidectomy: comparison with conventional open procedure after propensity score matching. Surg Laparosc Endosco Percutan Tech 24:67–72CrossRef Kim BS, Kang KH, Kang H et al (2014) Central neck dissection using a bilateral axillo-breast approach for robotic thyroidectomy: comparison with conventional open procedure after propensity score matching. Surg Laparosc Endosco Percutan Tech 24:67–72CrossRef
22.
Zurück zum Zitat Chai YJ, Suh H, Woo J-W et al (2017) Surgical safety and oncological completeness of robotic thyroidectomy for thyroid carcinoma larger than 2 cm. Surg Endosc 31:1235–1240CrossRefPubMed Chai YJ, Suh H, Woo J-W et al (2017) Surgical safety and oncological completeness of robotic thyroidectomy for thyroid carcinoma larger than 2 cm. Surg Endosc 31:1235–1240CrossRefPubMed
23.
Zurück zum Zitat Seup Kim B, Kang KH, Park SJ (2015) Robotic modified radical neck dissection by bilateral axillary breast approach for papillary thyroid carcinoma with lateral neck metastasis. Head Neck 37:37–45CrossRefPubMed Seup Kim B, Kang KH, Park SJ (2015) Robotic modified radical neck dissection by bilateral axillary breast approach for papillary thyroid carcinoma with lateral neck metastasis. Head Neck 37:37–45CrossRefPubMed
24.
Zurück zum Zitat Büttner M, Musholt TJ, Singer S (2017) Quality of life in patients with hypoparathyroidism receiving standard treatment: a systematic review. Endocrine 58:14–20CrossRefPubMed Büttner M, Musholt TJ, Singer S (2017) Quality of life in patients with hypoparathyroidism receiving standard treatment: a systematic review. Endocrine 58:14–20CrossRefPubMed
25.
Zurück zum Zitat Smith E, Verdolini K, Gray S et al (1996) Effect of voice disorders on quality of life. J Med Speech Lang Pathol 4:223–244 Smith E, Verdolini K, Gray S et al (1996) Effect of voice disorders on quality of life. J Med Speech Lang Pathol 4:223–244
26.
Zurück zum Zitat Gonçalves Filho J, Kowalski LP (2004) Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol 25:225–230CrossRef Gonçalves Filho J, Kowalski LP (2004) Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol 25:225–230CrossRef
28.
Zurück zum Zitat Kwak HY, Kim HY, Lee HY et al (2015) Robotic thyroidectomy using bilateral axillo-breast approach: comparison of surgical results with open conventional thyroidectomy. J Surg Oncol 111:141–145CrossRefPubMed Kwak HY, Kim HY, Lee HY et al (2015) Robotic thyroidectomy using bilateral axillo-breast approach: comparison of surgical results with open conventional thyroidectomy. J Surg Oncol 111:141–145CrossRefPubMed
29.
Zurück zum Zitat Lang BH-H, Wong CK, Tsang JS et al (2014) A systematic review and meta-analysis comparing surgically-related complications between robotic-assisted thyroidectomy and conventional open thyroidectomy. Ann Surg Oncol 21:850–861CrossRefPubMed Lang BH-H, Wong CK, Tsang JS et al (2014) A systematic review and meta-analysis comparing surgically-related complications between robotic-assisted thyroidectomy and conventional open thyroidectomy. Ann Surg Oncol 21:850–861CrossRefPubMed
30.
Zurück zum Zitat Ficarra V, Novara G, Rosen RC et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. European Urol 62:405–417CrossRef Ficarra V, Novara G, Rosen RC et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. European Urol 62:405–417CrossRef
31.
Zurück zum Zitat Steurer M, Passler C, Denk DM et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112:124–133CrossRefPubMed Steurer M, Passler C, Denk DM et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112:124–133CrossRefPubMed
32.
Zurück zum Zitat Hernandez J, Bann S, Munz Y et al (2004) Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system. Surg Endosc 18:372–378CrossRefPubMed Hernandez J, Bann S, Munz Y et al (2004) Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system. Surg Endosc 18:372–378CrossRefPubMed
Metadaten
Titel
A Propensity Score-matched Comparison Study of Surgical Outcomes in Patients with Differentiated Thyroid Cancer After Robotic Versus Open Total Thyroidectomy
verfasst von
Dong Sik Bae
Do Hoon Koo
Publikationsdatum
21.09.2018
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 2/2019
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4802-8

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