Surgical Outcomes of Robotic MRND versus Conventional Open MRND for Papillary Thyroid Carcinoma with Lateral Neck Node Metastasis: Comparative Analysis using PropensityScore Matching
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: During the past decade, various endoscopic thyroid surgeries have been conducted, each with its own benefits. The incorporation of robotic systems to endoscopic thyroid surgery has improved the visualization and precision of endoscopic techniques. We previously reported our initial experience with robotic modified radical neck dissection (MRND) of papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM). The aim of this study was to compare surgical outcomes of robotic vs. conventional open MRND of PTC with LNM using propensity score matching.Methods: From January 2008 to February 2011, 515 patients with PTC with LNM were enrolled. One hundred patients underwent robotic MRND, and 415 patients underwent conventional open MRND. These two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes, and surgical completeness. Furthermore, to avoid selection bias, propensity score matching analysis was used to compare surgical outcomes of each group without any compounding factors.Results: The operative time for the robotic MRND was longer than for the open MRND (297.9±60.2 min vs. 212.1±55.6 min, P=0.089). However, the mean numbers of retrieved lymph nodes and mean hospital stay after surgery were similar in the two groups (36.0±12.9 vs. 40.8±13.3, P=0.235), (6.1±1.6 days vs. 6.1±2.1 days, P=0.577). The complication rates were similar between the two groups, and there was no statistical difference in postoperative thyroglobulin levels between groups (0.51±0.83 ng/ml vs. 0.89±2.46 ng/ml, P=0.593).Conclusion: According to our study, robotic MRND shows similar surgical outcomes to conventional open MRND after case-matched analyses. We suggest that robotic MRND is an acceptable alternative as an operative method for PTC with LNM, resulting in excellent cosmesis and patient satisfaction.
Abstract
Purpose: During the past decade, various endoscopic thyroid surgeries have been conducted, each with its own benefits. The incorporation of robotic systems to endoscopic thyroid surgery has improved the visualization and precision of endoscopic techniques. We previously reported our initial experience with robotic modified radical neck dissection (MRND) of papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM). The aim of this study was to compare surgical outcomes of robotic vs. conventional open MRND of PTC with LNM using propensity score matching.Methods: From January 2008 to February 2011, 515 patients with PTC with LNM were enrolled. One hundred patients underwent robotic MRND, and 415 patients underwent conventional open MRND. These two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes, and surgical completeness. Furthermore, to avoid selection bias, propensity score matching analysis was used to compare surgical outcomes of each group without any compounding factors.Results: The operative time for the robotic MRND was longer than for the open MRND (297.9±60.2 min vs. 212.1±55.6 min, P=0.089). However, the mean numbers of retrieved lymph nodes and mean hospital stay after surgery were similar in the two groups (36.0±12.9 vs. 40.8±13.3, P=0.235), (6.1±1.6 days vs. 6.1±2.1 days, P=0.577). The complication rates were similar between the two groups, and there was no statistical difference in postoperative thyroglobulin levels between groups (0.51±0.83 ng/ml vs. 0.89±2.46 ng/ml, P=0.593).Conclusion: According to our study, robotic MRND shows similar surgical outcomes to conventional open MRND after case-matched analyses. We suggest that robotic MRND is an acceptable alternative as an operative method for PTC with LNM, resulting in excellent cosmesis and patient satisfaction.
참고문헌 (23)
- Caron NR, "Papillary thyroid cancer: surgical management of lymph node metastases", Curr Treat Options Oncol, 6, pp.311~322
- Kang SW, "Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients", Endocr J, 56, pp.361~369 (2009)
- Kang SW, "Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients", Surg Endosc, 23, pp.2399~2406 (2009)
- Kang SW, "Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach", J Am Coll Surg, 209, pp.e1~e7 (2009)
- Kang SW, "Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients", Surgery, 146, pp.1048~1055 (2009)
- Ryu HR, "Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach", J Am Coll Surg, 211, pp.e13~e19 (2010)
- Kang SW, "A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis", Surg Endosc, 26, pp.3251~3257 (2012)
- Choi JS, "Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT", AJR Am J Roentgenol, 193, pp.871~878 (2009)
- Kim MJ, "Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer", Clin Endocrinol, 70, pp.145~151 (2009)
- Lee J, "Is level IIb lymph node dissection always necessary in N1b papillary thyroid carcinoma patients?", World J Surg, 32, pp.716~721 (2008)
- Caron NR, "Selective modified radical neck dissection for papillary thyroid cancer-is level I, II and V dissection always necessary?", World J Surg, 30, pp.833~840 (2006)
- Kang SW, "Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis", Surgery, 148, pp.1214~1221 (2010)
- Hüscher CS, "Endoscopicright thyroid lobectomy", Surg Endosc, 11, pp.877~ (1997)
- Ikeda Y, "Endoscopic resection of thyroid tumors by the axillary approach", J Cardiovasc Surg, 41, pp.791~792 (2000)
- Ikeda Y, "Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery", Surg Endosc, 16, pp.1741~1745 (2002)
- Shimizu K, "Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound", J Am Coll Surg, 188, pp.697~703 (1999)
- Ohgami M, "Scarless endoscopic thyroidectomy: breast approach for better cosmesis", Surg Laparosc Endosc Percutan Tech, 10, pp.1~4 (2000)
- Lewis CM, "Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation", Head Neck, 32, pp.121~126 (2010)
- Landry CS, "Bilateral robotic-assisted transaxillary surgery", Arch Surg, 145, pp.717~720 (2010)
- Berber E, "Robotic transaxillary thyroidectomy: report of 2 cases and description of the technique", Surg Laparosc Endosc Percutan Tech, 20, pp.e60~e63 (2010)
- Lang BH, "A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors' initial experience", Surg Endosc, 25, pp.1617~1623 (2011)
- Kuppersmith RB, "Robotic thyroid surgery: an initial experience with North American patients", Laryngoscope, 121, pp.521~526 (2011)
- Landry CS, "Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands", Surgery, 149, pp.549~555 (2011)