Li Xiaolei, Chen Sijuan, Liu Yan, Cao Xianjiao, Xu Gaoyuan, Chen Lanqing, He Qingqing
Department of Thyroid and Breast Surgery, The 960th Hospital of People's Liberation Army, No.25, Shifan Road, Tianqiao District, Jinan, 250031, China.
Department of Thyroid and Breast Surgery, The Postgraduate Training Base of Jinzhou Medical University (The 960thHospital of PLA), Jinan, 250031, China.
Surg Endosc. 2025 Aug 8. doi: 10.1007/s00464-025-12014-7.
Our study aimed to evaluate and compare the surgical and oncological outcomes of robotic bilateral lateral neck dissection (LND) via the bilateral axillo-breast approach (BABA) with the conventional open procedures (COP) in patients with papillary thyroid carcinoma (PTC) and bilateral lateral neck metastasis (LNM).
The clinical data of 181 patients with PTC and bilateral LNM who underwent robotic bilateral LND or COP (61:120) between April 2018 and February 2024 at our institution were retrospectively analyzed. 36 matched pairs were generated using a 1:1 propensity score matching (PSM) method.
All robotic BABA bilateral LND procedures were successfully completed without conversion to open surgery. PSM analysis revealed that the postoperative stay, drainage volume, and the numbers of retrieved or metastatic lymph nodes were comparable between the matched groups. However, the operating time was significantly longer in the robotic group compared to the open group (p < 0.001). Furthermore, there were no significant differences between the two groups in terms of hypoparathyroidism (p = 0.637), vocal cord palsy (p = 1), and chyle leakage (p = 1). Additionally, there was no recurrence in either group. Notably, the aesthetic score was significantly higher in the robotic group compared to the open group (median, [IQR] 9 [IQR: 8-10] versus. 5 [IQR: 3-5], p < 0.001).
Robotic BABA bilateral LND resulted in comparable surgical outcomes and superior cosmetic in a cohort of patients with papillary thyroid carcinoma and bilateral lateral neck metastasis.
我们的研究旨在评估和比较机器人辅助经双侧腋窝-乳房入路（BABA）行双侧侧颈淋巴结清扫术（LND）与传统开放手术（COP）在乳头状甲状腺癌（PTC）伴双侧侧颈淋巴结转移（LNM）患者中的手术及肿瘤学结局。
回顾性分析2018年4月至2024年2月在我院接受机器人辅助双侧LND或COP（61例：120例）的181例PTC伴双侧LNM患者的临床资料。采用1:1倾向评分匹配（PSM）方法生成36对匹配病例。
所有机器人辅助BABA双侧LND手术均成功完成，无需转为开放手术。PSM分析显示，匹配组之间的术后住院时间、引流量以及获取或转移淋巴结数量相当。然而，机器人组的手术时间明显长于开放组（p < 0.001）。此外，两组在甲状旁腺功能减退（p = 0.637）、声带麻痹（p = 1）和乳糜漏（p = 1）方面无显著差异。另外，两组均无复发。值得注意的是，机器人组的美学评分明显高于开放组（中位数，[四分位间距] 9 [四分位间距：8 - 10] 对 5 [四分位间距：3 - 5]，p < 0.001）。
在乳头状甲状腺癌伴双侧侧颈淋巴结转移患者队列中，机器人辅助BABA双侧LND的手术结局相当，美容效果更佳。
