Five-Year Oncologic Outcome and Surgical Completeness of Transoral Robotic Thyroidectomy for Papillary Thyroid Carcinoma: Comparison with Conventional Transcervical Thyroidectomy Using Propensity Score Matching

Ultrasound-guided radiofrequency ablation for isthmus papillary thyroid microcarcinoma: a prospective 2 years of follow-up study

To explore the safety and clinical efficacy of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) located in the isthmus. This prospective study enrolled patients with single isthmus PTMC admitted to General Surgery Department of 983rd Hospital of Joint Logistic Support Force of PLA from 2017 to 2022. After ablation, the ultrasound and contrast-enhanced ultrasound (CEUS) were performed to follow up the outcomes at 1, 3, 6, 12, 18, and 24 months. The volume reduction rates (VRR), disappearance rates (DR), incidence of complications, recurrence, and lymph node metastasis were recorded. A total of 135 patients were enrolled in this study, including 26 men and 109 women. The average age was 41.07±13.60 years old. The average diameter of PTMC was 0.68 ±0.17cm. After ablation, the DRs at 1, 3, 6, 12, 18 months, and 24 months were 0.0% (0/135), 10.4% (14/135), 52.6% (71/135), 81.5% (110/135), 100% (135/135), and 100% (135/135), and the VRRs at 1, 3, 6, 12, 18 months, and 24 months were 66.18±12.57%, 82.42±12.01%, 93.33±8.70%, 98.58±3.71%, 100.00±0.00%, 100.00±0.00%. Two patients suffered recurrence of PTMC in the thyroid at 6 and 12 months after ablation, and one patient suffered cervical lymph node metastases at 18 months after ablation. No patient had serious complications, including death, hemorrhage, or thermal injury to peripheral organs. RFA was a safe and effective treatment for isthmus PTMC, which may add new choices to the treatment strategy for patients.

Current and Future of Robotic Surgery in Thyroid Cancer Treatment

Thyroid cancer is among the most common endocrine malignancies, necessitating effective surgical interventions. Traditional open cervicotomy has long been the standard approach for thyroidectomy. However, the advent of robotic surgery has introduced new possibilities for minimally invasive procedures with benefits in terms of cosmetic outcomes, enhanced precision, comparable complication rates, and reduced recovery time. This study mainly reviewed the most widely used and well-known robotic thyroidectomy approaches: the transaxillary approach, the bilateral axillo-breast approach, and the transoral approach. This review examines the current status and future potential of robotic surgery in thyroid cancer treatment, comparing its efficacy, safety, and outcomes with those of conventional open cervicotomy. Challenges such as a longer operative time and higher costs exist. Future directions include technological advancements, tele-surgery, single-port surgery, and the integration of artificial intelligence. Robotic surgery holds promise in optimizing patient outcomes in thyroid cancer treatment.

Oncologic outcomes and surgical completeness of remote-access thyroidectomy: a systematic review and network meta-analysis

BACKGROUND

The oncologic safety and surgical completeness of remote-access thyroidectomies are not yet clearly established. This study evaluates the oncologic outcomes and surgical completeness of three prevalent remote-access thyroidectomies: the gasless transaxillary approach (GTAA), bilateral axillo-breast approach (BABA), and transoral approach (TOA), in comparison with conventional transcervical thyroidectomy (CTT).

METHODS

Literature searches were conducted in PubMed, EMBASE, and the Cochrane Library databases, covering the period from 2000 to 2023. Network meta-analyses were performed on selected studies, focusing on recurrence and surgical completeness. Surgical completeness was assessed using stimulated serum thyroglobulin levels and the count of retrieved lymph nodes.

RESULTS

The review included 48 studies, encompassing a total of 16,356 patients. The number of retrieved lymph nodes was comparable among BABA, TOA, and CTT, while GTAA might be less effective. Stimulated serum thyroglobulin levels showed no significant differences across the four groups. However, the proportion of patients with stimulated thyroglobulin levels below 1.0 ng/mL was significantly lower in GTAA compared to the other groups. The overall recurrence rates were 1.31% for CTT, 0.89% for GTAA, 0.62% for BABA, and 0% for TOA, with no significant differences in recurrence rates when adjusted for follow-up duration.

CONCLUSIONS

This study demonstrated that the oncologic outcomes of GTAA, BABA, and TOA are comparable to those of CTT, based on recurrence rates. In terms of surgical completeness, BABA and TOA showed equivalence to CTT, whereas GTAA might be inferior to the other techniques.

Comparison of surgical outcomes of transoral robotic and endoscopic thyroidectomy: A systematic review and network meta-analysis

This study aimed to compare surgical outcomes of transoral robotic thyroidectomy (TORT) and transoral endoscopic thyroidectomy vestibular approach (TOETVA), concurrently compared with conventional transcervical thyroidectomy (CTT). A network meta-analysis, comprising 23 studies, was performed in this study. The operative time of the CTT group was significantly shorter than that of the TOETVA and TORT groups. The hospital stay of the TOETVA group was significantly longer than that of the CTT group. Rates of transient recurrent laryngeal nerve palsy and total complications were higher in association with TOETVA than with TORT. No significant differences were found between the three groups in intraoperative blood loss, retrieved lymph nodes, postoperative pain, and other complications. Cosmetic satisfaction was significantly superior with TORT and TOETVA than with CTT. Compared with CTT, TOETVA and TORT showed superior cosmesis but no significant difference in surgical outcomes except for operative time and hospital stay.

TOETVA: a single surgeon's learning curve and a case report of CASTLE thyroid tumor

BACKGROUND

Owing to the lack of visible scars, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers superior aesthetic outcomes compared to conventional thyroidectomy. Carcinoma showing thymus-like differentiation (CASTLE) represents a rare thyroid gland neoplasm. This study aimed to explore the TOETVA learning curve and present a case report of CASTLE.

METHODS

A study with precise 1:1 matching was conducted to assess the procedure safety and cancer control outcomes of TOETVA in comparison to conventional surgery between May 2020 and May 2023. Cumulative sum analysis was employed to optimally fit the learning curve. Subsequently, a case report of CASTLE treated with TOETVA surgery was presented.

RESULTS

The mean operative time was longer in the TOETVA group than in the open group. The TOETVA group had a higher incidence of skin numbness and excellent cosmetic outcomes compared to the open group. The learning curves for work area preparation, unilateral thyroid lobectomy, and the entire surgical process were 59, 28, and 50 cases, respectively. There were no differences between the learning and proficient groups, except for operative time, intraoperative blood loss, and drainage volume on the first postoperative day.

CONCLUSIONS

A comprehensive analysis of the TOETVA learning curve utilizing cumulative and analytical methods demonstrated the feasibility of TOETVA with regards to surgical integrity, safety, and oncological safety. This study's findings suggest that a surgeon's cumulative number of TOETVA cases exceeding 50 can reach the mastery stage. Moreover, diagnosing CASTLE is challenging and necessitates immunohistochemical detection of relatively specific markers associated with thymic epithelial tumors.