Expanding indications of robotic thyroidectomy

Robotic thyroidectomy has many advantages with comparable oncologic safety over conventional open surgery in low-risk differentiated thyroid cancer cases. However, there have been few reports on the outcomes of patients who have been treated with robotic thyroidectomy for more advanced thyroid cancer. The aim of this study was to investigate the validity of expanding indications of robotic thyroidectomy for more advanced thyroid cancer. The data of 80 patients with thyroid cancer who underwent robotic total thyroidectomy between January 2013 and December 2014 performed by a single surgeon at Chung-Ang University Hospital were retrospectively reviewed. Among them, 40 patients who had cancer larger than 2 cm or suspicious capsular invasion, or central lymph node (LN) metastasis in preoperative pathologic and radiologic examinations were categorized into the more advanced thyroid cancer group and the remaining patients into the early thyroid cancer group. We compared surgical safety and surgical completeness parameters between the two groups. The patients in more advanced thyroid cancer group had larger tumors, more extrathyroidal extension, and higher T stages. Surgical safety parameters, such as hypoparathyroidism, vocal cord palsy, and other complications did not differ significantly between the two groups. Surgical completeness parameters, such as the mean number of retrieved LNs, median values of the stimulated thyroglobulin levels, and the proportion of patients with stimulated thyroglobulin levels less than 1 ng/mL, also did not differ significantly. The outcomes of the patients with more advanced thyroid cancer who were treated with robotic thyroidectomy were comparable to those of the early cancer group patients. Well-designed investigations that are conducted at multiple centers are needed to affirm the validity of expanding indications of robotic thyroidectomy.