Longitudinal health-related quality of life after remote-access versus open thyroidectomy for thyroid cancer: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Pooled standardized mean difference and mean difference calculated (specific values not provided in abstract)

• Primary Outcome: Health-related quality of life showed early advantages for RAT at 1 and 3 months that dissipated long-term

• Nnt Or Sensitivity: Cosmetic satisfaction and swallowing function consistently favoured RAT from 1-2 weeks through 6 months

• Confidence Interval: Not reported in abstract

Clinical Application

RAT requires specialised training and equipment; availability varies significantly across Australian centres Limited RAT availability in Australia; PBS coverage considerations for robotic procedures; RACS guidelines for credentialing in robotic surgery relevant Thyroid cancer patients considering surgical approach, particularly those prioritising cosmetic outcomes and early quality of life

Abstract

As remote-access thyroidectomy (RAT) becomes more widely used, evidence on patient- reported outcomes, particularly health-related quality of life (HRQoL), remains scarce and inconsistent. This meta-analysis compared postoperative HRQoL between thyroid cancer (TC) patients undergoing RAT and open thyroidectomy (OT) and assessed changes over time. A comprehensive search of five major databases was conducted from inception to August 2025. Studies reporting HRQoL after RAT or OT were included. Outcomes were grouped by postoperative timepoints. Outcomes were stratified across distinct postoperative timepoints to calculate pooled standardized mean difference (SMD) or mean difference (MD). Heterogeneity was explored through rigorous subgroup analyses encompassing surgical modalities, countries, and assessment instruments. Forty-one studies met the inclusion criteria, and 29 records were included in the quantitative synthesis. RAT demonstrated early advantages in comprehensive quality of life at 1 month and 3 months, and these advantages dissipated long term. Pain trajectories exhibited a biphasic pattern: RAT was associated with lower pain scores on postoperative day 1 but paradoxically higher scores during the 1-2 week period, with subsequent convergence. Cosmetic satisfaction and swallowing function consistently favored RAT from 1-2 weeks through 6 months, while voice outcomes showed no discernible differences. RAT appears to confer selected short- to medium-term patient-reported advantages over OT, particularly in cosmetic satisfaction and swallowing function. But these benefits are heterogeneous and not consistently maintained across all domains or timepoints. Future studies should standardize cross-culturally validated PRO instruments and adopt harmonized follow-up intervals and reporting guidelines to clarify the patient-centered value of RAT.

References

1. 1.Ma, Q., Liu, J., Zhang, L., Li, C., Cai, Y., Zhou, Y., Shui, C., Yang, Y., Zhang, S., & Sun, R. (2026). Longitudinal health-related quality of life after remote-access versus open thyroidectomy for thyroid cancer: a systematic review and meta-analysis. Journal of Robotic Surgery. https://doi.org/10.3390/cancers14215265