Long-term outcomes of robotic vs. open thyroidectomy for differentiated thyroid cancer: efficacy, safety, and quality of life.
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OBJECTIVE: To compare robotic vs. open thyroidectomy's (OT) long-term safety, efficacy, and quality of life for differentiated thyroid cancer (DTC). BACKGROUND: Early research showed that robotic thyroid surgery better preserves parathyroid glands and nerves compared to open surgery, but its long-term efficacy and safety remain uncertain. Comparative studies across various extents of thyroidectomy should be enhanced to include long-term follow-up, large sample sizes, and robust evidence from extensive clinical experience. METHODS: This retrospective cohort study included 6249 patients who underwent open or robotic thyroidectomy (RT) in 2014-2024 at a 3:1 ratio (aged 15-80 years; 4659 females and 1590 males) from a cohort of 11 733 who underwent OT or RT were analyzed. Postoperative complications were recorded, and patients were assessed using quality of life and aesthetic outcome scales. Patients were evaluated using Short Form-36, voice/swallowing/neck impairment scales, and the SCAR-Q questionnaire. Clinical-pathological characteristics, postoperative complications, quality of life, and aesthetic outcome scores were compared. RESULTS: Compared to the RT group, the OT group had a higher recurrence rate [135 (2.29%) vs. 29 (1.82%); P = 0.02], transient and permanent hypoparathyroidism ( P < 0.001) and permanent hoarseness rate ( P = 0.002). The OT group showed a marked decline in recurrence-free survival probability after 100 months postsurgery, falling below that of the RT group( P = 0.027). The OT group had higher swallowing and voice impairment scores than the RT group ( P < 0.001) and performed worse in physiological function, body pain, general health, vitality, social function, mental health, health change, and SCAR-Q scores ( P < 0.001) after surgery. CONCLUSIONS: Besides its well-recognized cosmetic benefits, RT demonstrated superior elegance, effectiveness, and safety across various surgical scopes, significantly enhancing the long-term postoperative quality of life for patients with DTC. These findings affirm RT as a valuable surgical option, particularly for those seeking enhanced cosmetic outcomes and requiring complex procedures.