Comparison Of Study Between Robotic Thyroidectomy Via Bilateral-axillo-breast Approach And Open Thyroidectomy For Differentiated Thyroid Carcinoma:a Meta Analysis

Objective: To systematically evaluate the efficacy of study between robotic thyroidectomy via bilateral-axillo-breast approach and open thyroidectomy for differentiated thyroid carcinoma.Methods: The literature was retrievd in Pub Med,Cochrane Library,Embase,Wanfang Database,VIP Database and CNKI in the database to January 2020,in English and Chinese.To find the literature about comparison of study between BABA RT and OT for differentiated thyroid carcinoma.Literature was independently searched,screened and quality evaluated by two researchers according to the inclusion and exclusion criteria.A meta-analysis was used to systematically evaluate a total of 23 indicators of surgical-related outcomes.All data were processed using Rev Man 5.3 and Stata 15.1 statistical software.Results: A total of 15 literatures were included in this study,all of which were non-randomized controlled studies.There were 3862 patients with differentiated thyroid carcinoma,including 1443 in the RT group and 2419 in the OT group.Meta analysis showed that as compared with the OT group,the patients in the BABA RT group were younger,with a higher percentage of female patients and cosmetic satisfaction scores,but had longer surgery time,higher hospitalization costs,a lower rate of temporary hypocalcemia,and a lower number of retrieved central lymph nodes.The differences were statistically significant(P<0.05).But there were no statistically significant differences among tumor diameter,BMI,length of stay,pain score on the first day after surgery,temporary RLN injury,permanent RLN injury,permanent hypocalcemia,postoperative bleeding,effusion,incision infection,chyle leakage,the number of metastased central lymph nodes,the number of retrieved lateral lymph nodes,postoperative s Tg level,the proportion of patients with postoperative s Tg<1.0ng/ml,and the rate of tumor recurrence rate(P>0.05).Further subgroup analysis showed that before September 2016(Subgroup A),as compared with the OT group,the number of retrieved central lymph nodes was less,thedifference was statistically significant(P<0.05);after September 2016(Subgroup B).The number of central lymph node was not statistically significant(P>0.05).Conclusions: For patients with differentiated thyroid carcinoma that were selected strictly,BABA RT could perform lobectomy,total thyroidectomy,and neck dissection.It was safe and feasible and it could achieve the same oncological effects as OT.There were not only no influence in surgical complications and postoperative quality of life,but also better in cosmetic results.However,BABA RT had higher cost and longer operation time.So individual patients needed to be selected in order to achieve a relative balance between their cosmetic effects and cost-effectiveness.The meta-analysis included non-randomized controlled studies.High-level evidence such as large samples and randomized controlled trials was still needed for further verification.