BABA robotic neck dissection shows similar outcomes to open surgery in selected thyroid cancer patients

A single-center hybrid cohort study compared bilateral axillo-breast approach (BABA) robotic surgery with open modified radical neck dissection for papillary thyroid carcinoma with lateral lymph node metastases. After propensity matching, 150 robotic cases were compared with 300 open cases; recurrence and complication rates were similar, while robotic surgery took longer and had better cosmetic outcomes.

Matched cohort: 150 robotic and 300 open cases
Robotic surgery took 40 minutes longer at the median
Nodal recurrence and complication rates were similar
Cosmetic outcomes favored the robotic approach

This single-center hybrid cohort study compared BABA robotic thyroidectomy with modified radical neck dissection (MRND) against open MRND in patients with papillary thyroid carcinoma and lateral cervical lymph node metastases. It included 150 prospectively enrolled robotic cases and 509 retrospectively identified open cases from 2018–2023. Propensity score matching produced groups of 150 robotic and 300 open cases. Robotic surgery was offered to carefully selected patients, including those with tumors under 3 cm and limited, unilateral nodal disease.

After matching, median operating time was longer with the robotic approach: 200 minutes versus 160 minutes (p<0.001). Central and lateral lymph node yields did not differ significantly. At median follow-up of 37 months in the robotic group and 39 months in the open group, nodal recurrence occurred in 3 patients (2.0%) and 10 (3.3%), respectively (p=0.426). Complication rates were not significantly different; no permanent hypoparathyroidism was reported in the robotic group. Cosmetic outcomes favored robotic surgery.

The findings suggest BABA robotic MRND may be an option for selected patients seeking to avoid a visible neck scar, but do not establish equivalence or broader applicability. The nonrandomized design, patient preference in procedure selection, single-center setting, and relatively limited follow-up constrain interpretation.

In practice

For patients with carefully selected, low-risk papillary thyroid cancer and limited lateral nodal disease who prioritize avoiding a visible neck scar, BABA robotic MRND is a potential surgical alternative. In this single-center propensity-matched cohort, nodal recurrence and complication rates were not significantly different from open surgery, and cosmetic outcomes favored the robotic approach, but operations were longer. The nonrandomized comparison, patient preference affecting treatment selection, and limited follow-up mean these findings do not establish equivalence or support generalizing to more extensive disease or other centers.

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Source

Surgical Endoscopy: Robotic surgery for papillary thyroid carcinoma with lateral cervical lymph node metastasis: a hybrid design, observational, propensity score matching cohort study ↗

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