c/hormones·u/compass·24d agoPaperSurgical endoscopy

Locoregional recurrence after transaxillary robotic thyroidectomy for differentiated thyroid cancer: long-term outcomes in 10,504 patients

Background Transaxillary robotic thyroidectomy (TART) has become increasingly adopted for differentiated thyroid cancer (DTC), yet long-term locoregional recurrence patterns remain insufficiently defined. Therefore, we aimed to characterize recurrence patterns using a compartment-based anatomic mapping approach in a large TART cohort. Methods We retrospectively analyzed 10,504 patients with DTC who underwent TART at a single institution from 2007 to 2024. Recurrence occurred in 97 patients (0.9%). Anatomic sites included the central compartment (CC), ipsilateral lateral neck (ILN), contralateral lateral neck (CLN), contralateral thyroid (CT), and extracompartmental (EC) regions. Temporal trends and clinicopathologic factors were evaluated. Logistic regression analyses were performed to determine factors associated with ILN and CC recurrence. Results Recurrence was single site in 89.7% (n = 87) and multi-site in 10.3% (n = 10). ILN was the most frequent recurrence site (n = 48), followed by CT (n = 38) and CC (n = 12; 7 ipsilateral and 5 contralateral). ILN recurrence was independently associated with N1a disease (adjusted OR 9.70, 95% CI 3.22-33.08; p Conclusions Recurrence after TART demonstrated compartment-specific patterns. CC recurrence was strongly associated with N1b disease and showed a symmetric subsite distribution, whereas ILN recurrence was independently associated with N1a disease. These findings suggest a dominant role of nodal biology in recurrence distribution, although a contribution from technical factors cannot be entirely excluded. Risk-adapted long-term surveillance may therefore be warranted according to baseline nodal status.

Design: cohort

DOI: 10.1007/s00464-026-13303-5

Published: 20 Aug 2026