Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Department of Gynecology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
Surg Endosc. 2017 Oct;31(10):3985-4001. doi: 10.1007/s00464-017-5433-0. Epub 2017 Mar 23.
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.
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.
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).
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.
尽管机器人手术为微创甲状腺手术提供了新的技术选择，但机器人甲状腺切除术（RT）在甲状腺癌中的作用仍存在很大争议。本文旨在通过比较 RT 和开放甲状腺切除术（OT）的手术结果和肿瘤学结果进行系统评价和荟萃分析。
从 2016 年 7 月前的各种数据库中检索相关文献，包括 PubMed、MEDLINE、EMBASE、Cochrane 图书馆、Web of Science 和 ClinicalTrials.gov。感兴趣的结果包括患者特征、手术结果、不良事件和并发症、复发率以及手术完整性。
该系统评价和荟萃分析基于从 23 篇文献中选择的 5200 例患者。RT 与同等的不良事件和并发症发生率相关，包括短暂性低钙血症、永久性低钙血症、暂时性声音嘶哑、永久性喉返神经（RLN）麻痹、暂时性甲状旁腺功能减退症、永久性甲状旁腺功能减退症、血肿、术后出血、血清肿、乳糜漏、嗓音障碍指数-10（VHI-10）评分，以及同等的手术完整性，包括术后放射性碘（RAI）消融率、RAI 消融次数、平均总 RAI 消融剂量、术后 RAI 刺激 Tg、第一次消融后刺激 Tg<1.0ng/ml 的比例。此外，RT 术中出血量较少（WMD-1.47，p=0.04），淋巴结清扫数量较少（WMD-1.21，p=0.0002），吞咽障碍程度较轻（WMD-4.17，p<0.00001），美容满意度较高（OR 4.05，p<0.00001）。然而，OT 与较短的手术时间（WMD 69.80，p<0.00001）、较少的总引流量（WMD 66.53，p<0.0001）和较低的术后血清 Tg 水平（WMD 0.21，p<0.00001）相关。
RT 治疗甲状腺癌与 OT 同样安全。基于长期随访和手术完整性，RT 的不良事件和并发症以及复发率与 OT 相当。RT 术中出血量较少，淋巴结清扫数量较少，吞咽障碍程度较轻，美容满意度较高。相比之下，OT 与较短的手术时间、较小的总引流量和较低的术后血清 Tg 水平相关。总的来说，仍需要随机临床试验和更大的患者队列进行长期随访，以进一步证明机器人方法的价值。
