Successful Treatment of Differentiated Thyroid Carcinoma with Transaxillary Robotic Surgery and Radioiodine: The First European Experience

Abstract

Objectives: Transaxillary robotic thyroidectomy surgery (TARS) has been reported to be a safe approach in patients with differentiated thyroid carcinoma, and oncological responses are promising. Study Design: This study aimed to evaluate the oncological outcomes of TARS followed by radioiodine (RAI) therapy in patients with differentiated thyroid carcinoma. Between 2011 and 2016, patients treated for differentiated thyroid carcinoma by TARS in a single institution, followed by RAI, were retrospectively included. The oncological response was performed according to the 2015 American Thyroid Association (ATA) guidelines 6–12 months later and at the last available visit. Results: A total of 42 patients (30 females) were included, with a median tumor size of 20 mm (12 cases of N1a and 5 cases of N1b on initial pathology report). According to ATA classification of recurrence risk after surgery, 17 and 25 patients were classified as low and intermediate risk, respectively. After RAI, all patients had a normal posttherapeutic whole body scan (except 1 patient, who had pathological lymph node uptake), but no unusual uptake was seen. At the 6- to 12-month evaluation (n = 37), 24 patients had excellent response, 8 had indeterminate response, and 5 had incomplete response (2 biological and 3 structural); no distant metastasis was found. At the last evaluation (median follow-up 15.9 months), 35 patients had no evidence of disease and 1 patient had a structural incomplete response. In total, a second open surgery was necessary for 3 patients to treat persistent lymph nodes (all intermediate risk). Conclusion: In this study, TARS followed by RAI therapy seems to be curative, even for patients with lymph node metastases, after good preoperative staging. More studies are required to confirm the findings.

Robot‐assisted transaxillary surgery for thyroid cancer: Oncologic and surgical outcomes in long term follow‐up

“…[16][17][18][19] The data for most of these reports have come from Asian populations, and only a few publications have reported outcomes for Western patients. 7,9,[20][21][22] In some Asian countries, the screening campaigns have led to overdiagnosis of thyroid cancer, reflecting the small size of cancers presented in many series. 17,19,23 The rapid spread of robotic systems also for endocrine surgery led to the need to adapt the surgical procedures and their extension to the Western population.…”

“…1,2 Recently, the growing incidence of the diagnosis of thyroid cancer, especially in young women, has led to the request for surgical approaches with better cosmetic results because scar-associated problems in the cervical region can be of concern for patients. [3][4][5] Although data from Asian countries have demonstrated the safety and feasibility of robot-assisted thyroid cancer surgery, 6 few studies have addressed the use of roboticassisted thyroidectomy in the European population [7][8][9] This study analysed the long-term follow-up, the structural and biochemical recurrence rate data, and surgical complications among patients diagnosed with thyroid carcinoma treated with singleincision, gasless, robot-assisted transaxillary surgery. � Absence of history of head or neck radiation therapy.…”

“…Recently, the growing incidence of the diagnosis of thyroid cancer, especially in young women, has led to the request for surgical approaches with better cosmetic results because scar‐associated problems in the cervical region can be of concern for patients 3–5 . Although data from Asian countries have demonstrated the safety and feasibility of robot‐assisted thyroid cancer surgery, 6 few studies have addressed the use of robotic‐assisted thyroidectomy in the European population 7–9 …”

Quality of life and surgical outcome of ABBA versus EndoCATS endoscopic thyroid surgery: a single center experience

“…In Asian countries, however, endoscopic techniques are already well established not only for the radical resection of cancer but also for central as well as selective lateral lymph node dissection in thyroid cancer patients [ 11 , 25 , 28 , 29 , 38 , 40 , 41 , 50 ]. In Europe there have been some first successful experiences with the transaxillary robotic approach in selected patients with differentiated thyroid cancer for thyroid resection and central lymph node dissection [ 51 ].…”

Robot-Assisted Thyroidectomy Versus Open Thyroidectomy in the Treatment of Well Differentiated Thyroid Carcinoma

“…The size limit is commonly set at > 20 – 40 mm for low-risk differentiated thyroid carcinoma, and > 50 mm for benign or indeterminate nodules. 9 Currently, RT using a transaxillary approach has gained popularity and has been performed in many institutions. However, some surgeons still show reservations about it compared with traditional open thyroidectomy, given that the latter has already generated excellent results.…”