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

BACKGROUND: Evidence regarding robotic thyroidectomy with modified radical neck dissection (MRND) for papillary thyroid carcinoma with lateral cervical lymph node metastases remains limited, particularly from prospectively large-sample cohorts. METHODS: This hybrid cohort design study included 150 prospectively enrolled patients who underwent bilateral axillo-breast approach (BABA) robotic thyroidectomy with MRND between 2018 and 2023, and 509 retrospectively identified patients who underwent open MRND by the same surgical team during the same period. Propensity score matching (PSM) was performed at a ratio of 1:2 to balance prespecified tumor-related characteristics, resulting in 150 robotic and 300 matched open cases. Patient demographics, surgical profiles, oncological outcomes, and cosmetic virtues were compared. RESULTS: After PSM, the groups were well balanced in the prespecified tumor-related characteristics. Robotic MRND was associated with a longer operation time (200.00 [185.00, 220.00] vs 160.00 [140.00, 190.00], p < 0.001), whereas the number of retrieved central or lateral lymph nodes was similar between groups (p = 0.094; p = 0.296). During a median follow-up period of 37.0 months in the robotic group and 39.0 months in the open group, lymph node recurrence occurred in three (2.0%) and ten (3.3%) patients, respectively (p = 0.426). No significant differences were observed in complication rates between groups, and no permanent hypoparathyroidism occurred in the robotic group. The robotic approach achieved superior cosmetic outcomes. CONCLUSIONS: In carefully selected patients with low-risk papillary thyroid cancer and lateral lymph node metastases, robotic MRND via BABA demonstrated comparable safety and oncological completeness to the open approach, while offering superior cosmetic outcomes. RESEARCH REGISTRATION UNIQUE IDENTIFICATION NUMBER (UIN): ClinicalTrials.gov Identifier: NCT07229859.