Impact of tumor size on oncological and surgical outcomes in robot-assisted transaxillary surgery for papillary thyroid carcinoma

Background

Robot-assisted transaxillary thyroidectomy (RATT) has emerged as a remote access approach for differentiated thyroid carcinoma (DTC), yet data on its oncological efficacy for tumors larger than 3 cm, particularly in European cohorts, remain scarce. This study aimed to evaluate surgical and oncological outcomes of RATT in patients with papillary thyroid carcinoma (PTC), stratified by tumor size.

Materials and methods

We retrospectively reviewed 270 patients with histologically confirmed PTC who underwent RATT between July 2012 and August 2022 at a single tertiary center. Patients were categorized into two groups based on tumor size: Group A (<3 cm, n = 226) and Group B (≥3 cm, n = 44). Surgical outcomes, complication rates, and oncological parameters—including serum thyroglobulin (Tg) levels, anti-thyroglobulin antibodies, and structural recurrence—were analyzed. Subgroup analysis was conducted based on radioiodine ablation (RAI) status.

Results

No significant differences were observed between groups in terms of operative time, hospital stay, or postoperative complications. Tg levels after RAI were comparable between Group A and Group B (p = 0.999), indicating similar biochemical response. Only one patient experienced structural recurrence during follow-up (mean: 48 ± 31 months). Patients who underwent lobectomy alone showed no evidence of recurrence regardless of tumor size. No independent predictors of Tg levels were identified.

Conclusions

RATT appears to be a safe and oncologically effective approach for PTC, even for tumors ≥3 cm. These findings support the broader use of RATT in selected patients, with outcomes comparable across tumor sizes. Further multicenter studies with longer follow-up are warranted to validate these results.