Safety and feasibility of robotic reoperation via a bilateral axillo-breast approach for patients with locally recurrent thyroid cancer: a single-center retrospective study

摘要

Background: For patients with recurrent thyroid cancer, traditional open re-operative surgeries often leave conspicuous cervical scars, significantly impacting patients' long-term quality of life. The potential for robotic surgery to enhance the aesthetic outcomes of re-operative surgery and improve the quality of life for these patients has rarely been studied. This study aimed to assess the feasibility and effectiveness of robotic reoperation for recurrent thyroid cancer following initial surgery, offering a viable surgical alternative tailored to patients with heightened aesthetic concerns. Methods: We conducted a retrospective analysis of patients with recurrent thyroid cancer who underwent robotic reoperation via the bilateral axillo-breast approach (BABA) at the 960th Hospital of People's Liberation Army between September 2018 and March 2024. The study design involved a comprehensive review of clinical data, including patient demographics, surgical outcomes, and postoperative complications. Results: A cohort of 24 patients (18 females, 6 males) with a mean age of 34.13±10.06 years successfully underwent robotic BABA reoperation without conversion to open surgery. Two patients underwent completion total thyroidectomy (CTT) with central neck node dissection (CND), four underwent CTT with lateral neck dissection (LND), and the remaining 18 patients received LND alone. Histopathological examination revealed papillary thyroid carcinoma (PTC) in 23 patients and medullary thyroid carcinoma (MTC) in one patient. The mean number of lymph nodes retrieved from LND was 14.21±12.30, with 2.74±2.64 nodes harboring metastases. Postoperative complications were transient, including hypoparathyroidism in four patients and temporary vocal cord palsy in one patient, with no permanent complications reported. During an average follow-up period of 29.71±19.29 months, no recurrences were detected. Cosmetic satisfaction was assessed and yielded a median satisfaction score of 9.2. Conclusions: Robotic BABA reoperation emerges as a feasible and safe surgical modality for managing recurrent thyroid cancer, offering effective treatment while catering to patients' high aesthetic demands.