Qin Xiangquan, Zhang Yufan, Luo Jia, Zeng Lingjuan, Liu Xia, Zhang Ting, Ren Lin, Fan Linjun, Huang Dingde
Department of Breast and Thyroid Surgery, The Southwest Hospital of Army Military Medical University.
Department of Nuclear Medicine, The Southwest Hospital of Army Military Medical University.
Int J Surg. 2025 Jan 1;111(1):153-159. doi: 10.1097/JS9.0000000000002071.
To assess the efficacy and safety of robotic thyroidectomy (RT) with super-meticulous capsular dissection (SMCD) versus open thyroidectomy (OT), the authors used a dynamic risk assessment system incorporating 131 I-WBS along with radioactive iodine (RAI) efficacy evaluation.
Currently, the therapeutic efficacy of robotic surgery remains controversial. The 131 I whole-body scan ( 131 I-WBS) dynamic risk assessment system can detect small residual thyroid tissues and lesions, which may be used as indicators for the surgical efficacy of RT or OT thyroidectomy in differentiated thyroid cancer (DTC).
This retrospective cohort study included 2349 patients who underwent total thyroidectomy followed by RAI therapy in our department between August 2017 and June 2023. Propensity score matching was performed at a ratio of 1:3 based on surgical type and mean follow-up duration to minimize selection bias after excluding those lost to follow-up. The primary outcome was surgical completeness, assessed using a dynamic risk system incorporating 131 I-WBS along with RAI efficacy evaluation.
There was no significant difference in the number of metastatic lymph nodes removed between the two groups ( P =0.45). The incidence rate of parathyroid gland transplantation was 395 (68.7%) in the OT group and 8 (3.8%) in the RT group ( P <0.001). There were no differences in the thyroidectomy completeness based on the 3 h iodine uptake rate and 99m TcO 4- thyroid imaging between the two groups. The dynamic risk assessment with and without 131 I-WBS showed significant differences ( P <0.001). The postoperative and post-RAI dynamic risk scores, evaluated at the time of RAI and 6 months after RAI, did not differ significantly between the two groups ( P >0.05). The rates of transient and permanent hypoparathyroidism were higher in the OT group than in the RT group ( P <0.05). The local recurrence rates showed no significant difference between the groups.
This study demonstrates that RT with SMCD can achieve outcomes equivalent to those of traditional open surgery when integrating the 131 I-WBS dynamic evaluation system and the therapeutic effects of RAI. Additionally, robot surgery demonstrated a notable advantage in protecting parathyroid function.
为评估采用超精细被膜解剖（SMCD）的机器人甲状腺切除术（RT）与开放性甲状腺切除术（OT）的疗效和安全性，作者使用了一种动态风险评估系统，该系统结合了131I全身显像（131I-WBS）以及放射性碘（RAI）疗效评估。
目前，机器人手术的治疗效果仍存在争议。131I全身扫描（131I-WBS）动态风险评估系统可以检测到微小的残余甲状腺组织和病变，可作为分化型甲状腺癌（DTC）中RT或OT甲状腺切除术手术疗效的指标。
这项回顾性队列研究纳入了2017年8月至2023年6月期间在我科接受全甲状腺切除术后接受RAI治疗的2349例患者。根据手术类型和平均随访时间，以1:3的比例进行倾向评分匹配，以尽量减少排除失访患者后的选择偏倚。主要结局是手术完整性，采用结合131I-WBS和RAI疗效评估的动态风险系统进行评估。
两组切除的转移淋巴结数量无显著差异（P = 0.45）。OT组甲状旁腺移植发生率为395例（68.7%），RT组为8例（3.8%）（P < 0.001）。两组基于3小时碘摄取率和99mTcO4-甲状腺显像的甲状腺切除完整性无差异。有和没有131I-WBS的动态风险评估显示出显著差异（P < 0.001）。在RAI时和RAI后6个月评估的术后和RAI后动态风险评分在两组之间无显著差异（P > 0.05）。OT组短暂性和永久性甲状旁腺功能减退的发生率高于RT组（P < 0.05）。两组局部复发率无显著差异。
本研究表明，当整合131I-WBS动态评估系统和RAI的治疗效果时，采用SMCD的RT可取得与传统开放手术相当的结果。此外，机器人手术在保护甲状旁腺功能方面显示出显著优势。
