Comparison of short-term outcomes following minimally invasive (endoscopic/robotic) vs open thyroidectomy for patients with thyroid cancer.

Abstract

Background: Selection between open thyroidectomy (OT) and minimally invasive (endoscopic/robotic) thyroidectomy for patients with thyroid cancer has been a subject of considerable debate. Comprehensive analysis of the short-term outcomes of endoscopic thyroidectomy (ET), robotic-assisted thyroidectomy (RT) and open thyroidectomy (OT) for thyroid cancer using a large-scale dataset is important.

Methods: This cohort study evaluated the outcomes of patients receiving ET, RT or OT for thyroid cancer from January 1, 2003, to December 31, 2022. Propensity score matching (PSM) was performed among patients treated with ET, RT or OT to balance covariates distribution. This study involved single-institution patients (aged 18-70) who had undergone ET, RT or OT for thyroid cancer.

Results: The study included 11,066 thyroid cancer patients (OT group- mean (SD) age: 42.45 (10.84) years; ET group- mean (SD) age: 36.75 (9.32) years and RT group- mean (SD) age: 40.27 (10.42) years). After PSM for demographic and clinical characteristics, 908 matched pairs of patients (ET vs OT) and 1480 matched pairs (RT vs OT) were included for further analysis. Complication analysis revealed that RT was associated with a lower rate of transient hypoparathyroidism (339 (22.9%) vs 687 (46.4%); P < 0.001), a lower rate of permanent hypoparathyroidism (4 (0.3%) vs 16 (1.1%); P = 0.012) and a lower rate of transient recurrent laryngeal nerve injury (63 (4.3%) vs 89 (6.0%); P = 0.037).

Conclusion: This cohort study analyzed the short-term outcomes between ET, RT and OT in a large sample of patients with thyroid cancer over a period of two decades. PSM provided a comparable cohort, and the results suggested the advantage of RT, which reduced Clavien-Dindo grade Ⅰ complications in the surgical treatment of thyroid cancer.