Transoral robotic thyroidectomy vs. Open thyroidectomy for thyroid cancer: A propensity Score-Matched analysis

Transoral robotic thyroidectomy (TORT) offers a virtually scarless outcome but requires comparative validation studies against open thyroidectomy (OT). Patients who underwent thyroid surgery at our institution between January 2020 and October 2024 were enrolled. Through propensity score matching analysis, a final cohort of 322 adults with pathologically confirmed thyroid carcinoma was identified, comprising 161 patients in each group. We analyzed and compared clinical outcomes between the two surgical cohorts, along with patient-reported outcomes including Numerical Rating Scale (NRS) for pain, Voice Handicap Index-10 (VHI-10), and Scar Assessment Questionnaire-Cosmetic (SAQCO) for scar satisfaction assessed at 1 week postoperatively. Among the 322 propensity score-matched patients (age: median [IQR]: 41.0 [34.0, 51.0] years vs. 43.0 [34.0, 52.0] years; 231 females [71.7%], 91 males [28.3%]), the TORT group demonstrated significantly higher operative costs (median [IQR]: ¥63,351.0 [60,644.5, 64,948.8] vs. ¥19,009.6 [17,127.7, 21,774.4]; P < .001, BH-corrected q = 0.002) and longer operative duration (mean [SD]: 242.0 [55.8] min vs. 106.3 [38.4] min; mean difference: 136 min, 95% Cl: 125 - 146; P < .001, BH-corrected q = 0.002) compared to the OT group. However, the TORT group had significantly shorter postoperative hospitalization (mean [SD]: 2.8 [1.4] days vs. 3.4 [1.2] days; mean difference: -0.6 days; 95% Cl: 0.31- 0.88; P < .001, BH-corrected q = 0.002) and a lower incidence of transient hypoparathyroidism (5/161 [3.1%] vs. 29/161 [18.0%]; risk difference: -14.9, 95% Cl:-20.3 to -9.5; RR: 0.19, 95% Cl: 0.08 - 0.45); P < .001, BH-corrected q = 0.002). Patient-reported outcomes favored TORT, with significantly lower: NRS pain scores (median [IQR]: 3.0 [2.0, 4.0] vs. 7.0 [6.0, 8.0]; median difference: -4.0, 95% CI: -5.0 to -4.0; P < .001, BH-corrected q = 0.002). VHI-10 scores (median [IQR]: 38.0 [12.0, 59.0] vs. 77.0 [59.0, 89.0]; median difference: -39.0; 95% CI: -42.0 to -29.0; P < .001, BH-corrected q = 0.002). Conversely, scar satisfaction assessed via the SAQCO was significantly higher in the TORT group (median [IQR]: 20.0 [18.0, 23.0] vs. 14.0 [12.0, 17.0]; median difference: 6.0; 95% CI: 5.0 to 6.0; P < .001). No significant intergroup differences existed in lymph nodes harvested (median [IQR]: 7.0 [4.0, 11.0] vs. 8.0 [5.0, 12.0]; P = .06, BH-corrected q = 0.10) or metastatic lymph nodes dissected (median [IQR]: 0 [0, 2] vs. 1 [0, 3]; P = .06, BH-corrected q = 0.10). TORT achieves non-inferior perioperative outcomes compared to OT, with superior cosmetic results, reduced hospitalization duration. However, incurs significantly higher costs and longer operative times.