Robotic Thyroidectomy for Cancer in the US: Patterns of Use and Short-Term Outcomes
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We describe nationally representative patterns of utilization and short-term outcomes from robotic versus open thyroidectomy for thyroid cancer.
Descriptive statistics and multivariable analysis were used to analyze patterns of use of robotic thyroidectomy from the National Cancer Database (2010–2011). Short-term outcomes were compared between patients undergoing robotic versus open thyroidectomy, while adjusting for confounders.
A total of 68,393 patients with thyroid cancer underwent thyroidectomy; 225 had robotic surgery and 57,729 underwent open surgery. Robotic thyroid surgery use increased by 30 % from 2010 to 2011 (p = 0.08). Robotic cases were reported from 93 centers, with 89 centers performing <10 robotic cases. Compared with the open group, the robotic group was younger (51 vs. 47 years; p < 0.01) and included more Asian patients (4 vs. 8 %; p = 0.006) and privately-insured patients (68 vs. 77 %; p = 0.01). Tumor size was similar between patients undergoing robotic versus open surgery. Total thyroidectomy was performed less frequently in the robotic group (67 vs. 84 % open; p < 0.0001). Patients were relatively more likely to undergo robotic surgery if they were female (odds ratio [OR] 1.6; p = 0.04), younger (OR 0.8/10 years; p < 0.0001), or underwent lobectomy (OR 2.4; p < 0.0001). In adjusted multivariable analysis, there were no differences in the number of lymph nodes removed or length of stay between groups; however, there was a non-significant increase in the incidence of positive margins with robotic thyroidectomy.
Use of robotic thyroidectomy for thyroid cancer is limited to a few institutions, with short-term outcomes that are comparable to open surgery. Multi-institutional studies should be undertaken to compare thyroidectomy-specific complications and long-term outcomes.
KeywordsThyroid Cancer Robotic Surgery Papillary Thyroid Cancer Positive Surgical Margin Robotic Group
The authors report no conflicts of interest. The data used in this study are derived from a de-identified NCDB file. The ACS and the CoC have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.
- 2.American Cancer Society. Cancer facts & figures. 2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed 1 Mar 2014.
- 8.Song CM, Ji YB, Bang HS, Park CW, Kim H, Tae K. Long-term sensory disturbance and discomfort after robotic thyroidectomy. World J Surg. Epub 8 Feb 2014.Google Scholar
- 11.Lee J, Kwon IS, Bae EH, Chung WY. Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab. 2013;98(7):2701–8.PubMedCrossRefGoogle Scholar
- 14.Lee YM, Yi O, Sung TY, Chung KW, Yoon JH, Hong SJ. Surgical outcomes of robotic thyroid surgery using a double incision gasless transaxillary approach: analysis of 400 cases treated by the same surgeon. Head Neck. Epub 22 Aug 2013.Google Scholar
- 24.Kandil EH, Noureldine SI, Yao L, Slakey DP. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg. 2012;214(4):558–64; discussion 564–556.Google Scholar