An Jeongshin, Hwang Hyeonuk, Kim Hyeji, An Jungsuk, Kwon Hyungju, Moon Byung-In
Institute of Convergence Medicine Research, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
J Robot Surg. 2025 Aug 30;19(1):533. doi: 10.1007/s11701-025-02711-9.
Microscopic positive surgical margin (mPSM) is a known risk factor of recurrence in patients with differentiated thyroid cancer. While robotic thyroidectomy has gained acceptance as an alternative to open surgery, its impact on margin status remains unclear. This retrospective cohort study analyzed 2587 cases with differentiated thyroid cancer who underwent thyroid surgery between 2009 and 2023. Of these, 206 underwent robotic and 2381 underwent open thyroidectomy. The mPSM rate was comparable between robotic and open groups (4.4 vs. 3.9%, p = 0.743). Multivariable analysis identified larger tumor size, extrathyroidal extension, and multifocality as independent predictors of mPSM, whereas coexisting Hashimoto thyroiditis was associated with a decreased risk. Robotic approach was not an independent risk factor for mPSM (odds ratio 1.647, 95% CI 0.762-3.560). After propensity-score matching, mPSM rates remained similar (4.4% vs 3.4, p = 0.548). In conclusion, robotic thyroidectomy demonstrated oncologic safety comparable to that of open surgery in terms of microscopic margin involvement.
显微镜下手术切缘阳性（mPSM）是分化型甲状腺癌患者复发的已知危险因素。虽然机器人甲状腺切除术已被认可为开放手术的替代方法，但其对切缘状态的影响仍不明确。这项回顾性队列研究分析了2009年至2023年间接受甲状腺手术的2587例分化型甲状腺癌病例。其中，206例行机器人手术，2381例行开放甲状腺切除术。机器人手术组和开放手术组的mPSM率相当（4.4%对3.9%，p = 0.743）。多变量分析确定肿瘤体积较大、甲状腺外侵犯和多灶性是mPSM的独立预测因素，而并存桥本甲状腺炎与风险降低相关。机器人手术方法不是mPSM的独立危险因素（比值比1.647，95%可信区间0.762 - 3.560）。倾向评分匹配后，mPSM率仍然相似（4.4%对3.4%，p = 0.548）。总之，就显微镜下切缘受累情况而言，机器人甲状腺切除术显示出与开放手术相当的肿瘤学安全性。
