Central Neck Dissection Using a Bilateral Axillo-Breast Approach for Robotic Thyroidectomy: Comparison With Conventional Open Procedure After Propensity Score Matching

Abstract

Background: Despite advancements in surgical robot technology, the da Vinci-assisted central neck dissection (CND) in thyroid cancer remains challenging. The aim of this study is to evaluate the feasibility of robotic thyroidectomy and CND. Methods: Between March 2011 and July 2012, 515 consecutive patients who had undergone thyroidectomy and CND for papillary thyroid carcinoma were retrospectively reviewed. A thyroid surgeon performed either an open thyroidectomy and CND (n=392) or a robotic thyroidectomy and CND (n=123) using the bilateral axillo-breast approach (BABA). Propensity score matching using 10 clinicopathologic factors was used to generate 2 matched cohorts, each composed of 123 patients. Results: Mean age, body mass index, and tumor size were lower in those who underwent BABA compared with an open procedure before propensity matching. Evaluation of stimulated thyroglobulin levels did not show significant differences between the 2 groups. After cohort matching, significant differences in age, body mass index, and tumor size between the 2 groups were no longer present. The matched cohort showed that the number of retrieved lymph nodes was lower in the BABA (8.74 +/- 5.13) than in the open thyroidectomy (10.71 +/- 6.68) (P=0.006). Conclusions: BABA robotic thyroidectomy revealed that a less-extensive CND was obtained when compared with an open procedure. BABA may be suitable for thyroid cancer without lymphadenopathy in central neck compartment. Conversely, BABA should not be recommended to a patient with thyroid cancer when multiple lymph node metastases in the lower central neck compartment are suspected.