Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: a systematic review and meta-analysis.
BACKGROUND
Despite the new technical alternative offered by the robotic surgery for minimally invasive thyroid surgery, the role of the robotic thyroidectomy (RT) in thyroid cancer has been highly disputed. This paper gives a systematic review and meta-analysis aiming to compare RT and open thyroidectomy (OT) based on the surgical outcomes and oncologic results.


METHODS
Relevant literature was searched from various databases up to July 2016, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of science and Clinical Trials. gov. Outcomes of interest included patient characteristics, surgical outcomes, adverse events and complications, recurrence rate, and surgical completeness.


RESULTS
The systematic review and meta-analysis were based on the 5200 cases selected from the twenty-three publications. RT was associated with an equivalent adverse event and complication rate including transient hypocalcemia, permanent hypocalcemia, transient hoarseness, permanent recurrent laryngeal nerve (RLN) palsy, transient hypoparathyroidism, permanent hypoparathyroidism, hematoma, postoperative bleeding, seroma, chyle leakage, the Voice Handicap Index-10 (VHI-10) score, as well as equivalent surgical completeness including postoperative radioactive iodine (RAI) ablation rate, number of RAI ablation sessions, mean total RAI ablation dose, mean stimulated Tg of postoperation RAI, and proportion of stimulated Tg < 1.0 ng/ml on first ablation. Moreover, RT had lesser blood loss (WMD - 1.47, p = 0.04), smaller number of retrieved lymph nodes (WMD - 1.21, p = 0.0002), a low level of swallowing impairment (WMD - 4.17, p < 0.00001), and better cosmetic satisfaction (OR 4.05, p < 0.00001). However, OT was associated with shorter operation time (WMD 69.80, p < 0.00001), less total drain amount (WMD 66.53, p < 0.0001), and lower postoperative serum Tg level (WMD 0.21, p < 0.00001).


CONCLUSIONS
RT is as safe as OT for the treatment of thyroid cancer. Based on the long-time follow-up and surgical completeness, the adverse events and complications, and recurrence rate of RT were comparable with OT. RT was associated with a significantly lesser blood loss, smaller number of retrieved lymph nodes, a lower level of swallowing impairment, and better cosmetic satisfaction. In contrast, OT was associated with shorter operation time, smaller total drain amount, and lower postoperative serum Tg level. Overall, randomized clinical trials and larger patient cohort with long-term follow-up are still essential to further demonstrate the value of the robotic approach.
Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Jing-Hua
JH
Pan
Department of Gynecology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Hong
H
Zhou
Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Xiao-Xu
XX
Zhao
Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Hui
H
Ding
Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Li
L
Wei
Department of Histology and Embryology, Medical School of Jinan University, Guangzhou, 510632, China.
Li
L
Qin
Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China. tpanyl@jnu.edu.cn.
Yun-Long
YL
Pan
D006801:Humans; D006996:Hypocalcemia; D007011:Hypoparathyroidism; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000601:surgery; D011184:Postoperative Period; D065287:Robotic Surgical Procedures; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis
Meta-analysis; Open; Recurrence rate; Robotic; Thyroid cancer; Thyroidectomy