The Laryngoscope C 2014 The American Laryngological, V
Rhinological and Otological Society, Inc.
Systematic Review
A Systematic Review and Meta-analysis Evaluating Completeness and Outcomes of Robotic Thyroidectomy Brian Hung-Hin Lang, MS, FRACS; Carlos K. H. Wong, PhD; Julian Shun Tsang, MBBS, MRCS; Kai Pun Wong, MBBS, MRCS; Koon Yat Wan, MBBS, FRCR Objectives/Hypothesis: Despite immense interest, robotic-assisted thyroidectomy (RT) remains controversial in differentiated thyroid carcinoma (DTC). This systematic review and meta-analysis compared surgical completeness and/or oncological outcomes between RT and open thyroidectomy (OT) in low-risk DTC. Study Design: Systematic review. Methods: A systematic review was performed to identify studies that compared surgical completeness and/or oncological outcomes between RT and OT in DTC. Any study that compared at least one parameter relating to surgical completeness and/or oncological outcome for DTC was considered. Number of central lymph nodes (CLNs) retrieved during central neck dissection (CND), preablation stimulated thyroglobulin (sTg) level, radioiodine uptake on post-therapy scan, and locoregional recurrence (LRR) were examined. Meta-analysis was performed using a fixed or random-effects model depending on heterogeneity between studies. Results: Ten studies were eligible. Of the 2,205 DTCs, 752 (34.1%) had RT, whereas 1,453 (65.9%) had OT. Relative to OT, RT had signif icantly fewer CLNs retrieved during CND (4.7 6 3.2 vs. 5.5 6 3.8, standardized mean difference [SMD] 5 20.240, 95% confidence interval [CI]: 20.364 to 20.116, P 50%, results were analyzed using a random-effects model. Publication bias was estimated by Begg’s rank correlation test and Egger’s regression test.19 The metaanalyses in this study were conducted using IBM SPSS version 20.0 (IBM, Armonk, NY) for Windows (Microsoft Corp., Redmond WA) and Comprehensive Meta-Analysis Version 2.2.064 (Biostat, Inc., Englewood, NJ).
RESULTS Figure 1 shows the studies retrieved and excluded. Of the 485 titles initially identified from the database search, 20 full-length articles were assessed for inclusion, of which 10 were excluded, and 10 studies14,15,20–27 were determined to be eligible and were included in this systematic review. Table I lists these 10 excluded articles28–37 and the reason for their exclusion. No additional study was found from our search of the two bibliographies in previous meta-analyses.11,12 Of these 10 articles excluded, five were excluded mainly because their data were superseded by later studies.19,22–24
Patient Selection Ultrasonography was used as the routine preoperative imaging modality in all studies.14,15,20–27 The inclusion and exclusion criteria for RT or OT were similar. Inclusions included patient age between 21 and 65 years old, size of DTC 2 to 4 cm or less, thyroid lobe size 6 cm, and body mass index 36.14,15,20–27 Exclusions included previous neck irradiation, presence of lateral lymph node and distant metastases, and posteriorly Lang et al.: Completeness of Robotic Total Thyroidectomy
both PTC and follicular thyroid carcinoma (FTC).21,24 Overall, FTC only accounted for 0.2% of the entire DTC cohort. After checking the heterogeneity using a P value of v2 (P
Rhinological and Otological Society, Inc.
Systematic Review
A Systematic Review and Meta-analysis Evaluating Completeness and Outcomes of Robotic Thyroidectomy Brian Hung-Hin Lang, MS, FRACS; Carlos K. H. Wong, PhD; Julian Shun Tsang, MBBS, MRCS; Kai Pun Wong, MBBS, MRCS; Koon Yat Wan, MBBS, FRCR Objectives/Hypothesis: Despite immense interest, robotic-assisted thyroidectomy (RT) remains controversial in differentiated thyroid carcinoma (DTC). This systematic review and meta-analysis compared surgical completeness and/or oncological outcomes between RT and open thyroidectomy (OT) in low-risk DTC. Study Design: Systematic review. Methods: A systematic review was performed to identify studies that compared surgical completeness and/or oncological outcomes between RT and OT in DTC. Any study that compared at least one parameter relating to surgical completeness and/or oncological outcome for DTC was considered. Number of central lymph nodes (CLNs) retrieved during central neck dissection (CND), preablation stimulated thyroglobulin (sTg) level, radioiodine uptake on post-therapy scan, and locoregional recurrence (LRR) were examined. Meta-analysis was performed using a fixed or random-effects model depending on heterogeneity between studies. Results: Ten studies were eligible. Of the 2,205 DTCs, 752 (34.1%) had RT, whereas 1,453 (65.9%) had OT. Relative to OT, RT had signif icantly fewer CLNs retrieved during CND (4.7 6 3.2 vs. 5.5 6 3.8, standardized mean difference [SMD] 5 20.240, 95% confidence interval [CI]: 20.364 to 20.116, P 50%, results were analyzed using a random-effects model. Publication bias was estimated by Begg’s rank correlation test and Egger’s regression test.19 The metaanalyses in this study were conducted using IBM SPSS version 20.0 (IBM, Armonk, NY) for Windows (Microsoft Corp., Redmond WA) and Comprehensive Meta-Analysis Version 2.2.064 (Biostat, Inc., Englewood, NJ).
RESULTS Figure 1 shows the studies retrieved and excluded. Of the 485 titles initially identified from the database search, 20 full-length articles were assessed for inclusion, of which 10 were excluded, and 10 studies14,15,20–27 were determined to be eligible and were included in this systematic review. Table I lists these 10 excluded articles28–37 and the reason for their exclusion. No additional study was found from our search of the two bibliographies in previous meta-analyses.11,12 Of these 10 articles excluded, five were excluded mainly because their data were superseded by later studies.19,22–24
Patient Selection Ultrasonography was used as the routine preoperative imaging modality in all studies.14,15,20–27 The inclusion and exclusion criteria for RT or OT were similar. Inclusions included patient age between 21 and 65 years old, size of DTC 2 to 4 cm or less, thyroid lobe size 6 cm, and body mass index 36.14,15,20–27 Exclusions included previous neck irradiation, presence of lateral lymph node and distant metastases, and posteriorly Lang et al.: Completeness of Robotic Total Thyroidectomy
both PTC and follicular thyroid carcinoma (FTC).21,24 Overall, FTC only accounted for 0.2% of the entire DTC cohort. After checking the heterogeneity using a P value of v2 (P
