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Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes

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Abstract

Background

Robotic modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported to be a safe and meticulous technique in patients with papillary thyroid carcinoma (PTC) and lateral neck node metastasis (N1b). Few studies, however, have attempted to assess the long-term oncologic outcomes of robotic MRND in these patients. This study aimed to compare perioperative and 5-year oncologic outcomes of robotic MRND with conventional open procedures in patients with N1b PTC.

Methods

Between September 2007 and February 2010, 193 patients with N1b PTC underwent total thyroidectomy and MRND by a single surgeon. Of these, 42 (21.8 %) underwent robotic procedures and 151 (78.2 %) underwent conventional open procedures. All patients received 3.7- to 5.5-GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBSs), and diagnostic WBS (DxWBSs) during follow-up. An exact 1:3 matching for age and stage was performed to minimize selection bias, and perioperative and 5-year oncologic outcomes were compared in the matched groups.

Results

The mean follow-up period was 66.0 months (range 60–90 months). Number of retrieved cervical lymph nodes (LNs) (p = .102) and postoperative ablation success rates (p = .864) were similar between the two groups. TSH-suppressed serum Tg concentrations after 5 years (0.7 ± 1.5 vs. 2.4 ± 14.1 ng/ml; p = .471) and recurrence rates in the robotic and open groups (1/41 [2.4 %] vs. 3/102 [2.9 %]; p = .864) were similar for the 5-year follow-up period. Four patients experienced recurrence: Three exhibited regional lymph node metastasis, and one showed bilateral lung metastases.

Conclusion

The perioperative and 5-year oncologic outcomes were similar after robotic and conventional open MRND. Large, prospective randomized controlled trials with long-term follow-up data are needed to validate these results.

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Funding

This study was supported by a faculty research grant from Yonsei University College of Medicine for 2015 (6-2015-0056) (to WY Chung) and Intuitive Surgical Clinical Robotics Research Grant (to W.Y. Chung and J. Lee).

Author information

Correspondence to Woong Youn Chung.

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Disclosures

Min Jhi Kim, Jandee Lee, Seul Gi Lee, Jung Bum Choi, Tae Hyung Kim, Eun Jeong Ban, Cho Rok Lee, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Young Suk Jo, and Woong Youn Chung have no conflicts of interest or financial ties to disclose.

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Kim, M.J., Lee, J., Lee, S.G. et al. Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 31, 1599–1606 (2017). https://doi.org/10.1007/s00464-016-5146-9

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Keywords

  • Papillary thyroid cancer
  • Lateral neck node metastasis
  • Robotic surgery
  • Modified radical neck dissection
  • Oncologic outcome