Supplementary Material for: Successful Treatment of Differentiated Thyroid Carcinoma with Transaxillary Robotic Surgery and Radioiodine: The First European Experience

<b><i>Objectives:</i></b> Transaxillary robotic thyroidectomy surgery (TARS) has been reported to be a safe approach in patients with differentiated thyroid carcinoma, and oncological responses are promising. <b><i>Study Design:</i></b> This study aimed to evaluate the oncological outcomes of TARS followed by radioiodine (RAI) therapy in patients with differentiated thyroid carcinoma. Between 2011 and 2016, patients treated for differentiated thyroid carcinoma by TARS in a single institution, followed by RAI, were retrospectively included. The oncological response was performed according to the 2015 American Thyroid Association (ATA) guidelines 6–12 months later and at the last available visit. <b><i>Results:</i></b> A total of 42 patients (30 females) were included, with a median tumor size of 20 mm (12 cases of N1a and 5 cases of N1b on initial pathology report). According to ATA classification of recurrence risk after surgery, 17 and 25 patients were classified as low and intermediate risk, respectively. After RAI, all patients had a normal posttherapeutic whole body scan (except 1 patient, who had pathological lymph node uptake), but no unusual uptake was seen. At the 6- to 12-month evaluation (<i>n</i> = 37), 24 patients had excellent response, 8 had indeterminate response, and 5 had incomplete response (2 biological and 3 structural); no distant metastasis was found. At the last evaluation (median follow-up 15.9 months), 35 patients had no evidence of disease and 1 patient had a structural incomplete response. In total, a second open surgery was necessary for 3 patients to treat persistent lymph nodes (all intermediate risk). <b><i>Conclusion:</i></b> In this study, TARS followed by RAI therapy seems to be curative, even for patients with lymph node metastases, after good preoperative staging. More studies are required to confirm the findings.

<b><i>研究目的：</i></b> 经腋路机器人甲状腺切除术（Transaxillary Robotic Thyroidectomy Surgery, TARS）已被报道为分化型甲状腺癌患者的安全术式，其肿瘤学疗效表现喜人。<b><i>研究设计：</i></b> 本研究旨在评估分化型甲状腺癌患者接受经腋路机器人甲状腺切除术联合术后放射性碘（Radioiodine, RAI）治疗后的肿瘤学结局。本研究回顾性纳入2011年至2016年间，在单中心接受经腋路机器人甲状腺切除术治疗并后续行放射性碘治疗的分化型甲状腺癌患者。分别于术后6~12个月及末次随访时，参照2015年美国甲状腺协会（American Thyroid Association, ATA）指南标准评估患者的肿瘤学应答情况。<b><i>研究结果：</i></b> 本研究共纳入42例患者（其中女性30例），中位肿瘤直径为20 mm；初始病理报告显示12例存在N1a期淋巴结转移，5例存在N1b期淋巴结转移。根据术后美国甲状腺协会复发风险分层标准，17例患者归为低危组，25例归为中危组。放射性碘治疗后，所有患者的治疗后全身扫描结果均正常（仅1例存在病理性淋巴结摄取），未发现异常摄取灶。在术后6~12个月的评估队列（<i>n</i> = 37）中，24例患者获得极佳应答，8例为不确定应答，5例为不完全应答（其中2例为生物学不完全应答，3例为结构性不完全应答），未发现远处转移。末次随访时（中位随访时长15.9个月），35例患者无疾病证据，1例存在结构性不完全应答。总计3例患者因持续性淋巴结病变接受了二次开放手术（均为中危组患者）。<b><i>研究结论：</i></b> 本研究结果显示，经充分术前分期后，即便合并淋巴结转移的分化型甲状腺癌患者，接受经腋路机器人甲状腺切除术联合放射性碘治疗亦可达到根治效果。未来仍需开展更多研究以验证本研究结论。