Journal Article

Practice patterns for surgical management of low-risk papillary thyroid cancer from 2014 to 2019: A CESQIP analysis

Solórzano, Carmen C., Stephen, Antonia E., Wang, Tracy S., Kiernan, Colleen M., Wrenn, Sean M., Toumi, Asmae

2021

Overview

Patients with low-risk-PTC who undergo thyroid lobectomy (TL) have comparable disease-specific survival with lower morbidity than total thyroidectomy (TT). We aim to describe the surgical management of low-risk-PTC using the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP). CESQIP thyroidectomies of PTC tumors <4 cm were analyzed from 2014 to 2019 (n = 740). Postoperative outcomes were compared. Subgroup analysis examined temporal and institutional trends, and stratified for tumor size. Statistics utilized t-test, ANOVA, and Chi-squared. TT patients had greater hypoparathyroidism, operative time, and length-of-stay (all p < 0.001). Incidence of TL decreased with increasing tumor size (24.2% for <1 cm, 15.8% for 1–2 cm, 6.1% for 2–4 cm). TL rates increased from 2.0% in 2014 to 21.2% in 2018–19. Completion thyroidectomy was recommended in 12.0% of TL subjects. There was significant variation in TL rate by institution (p < .001). For low-risk-PTC, TT remained the most commonly utilized operation. TL rates increased following release of the new ATA guidelines. TT was associated with higher perioperative morbidity. Further insight is needed to understand factors influencing operative approach. •New ATA guidelines led to PTC practice changes, with increased use of lobectomy.•For confirmed-PTC of any size, total thyroidectomy remains most frequent approach.•Thyroid lobectomy had lower post-op hypoCa, shorter OR times, and shorter LOS. This study analyzed trends over the last five years at CESQIP-participating centers for the surgical management of low-risk papillary thyroid cancer, with particular attention paid to changes in practice related to the release of the 2015 American Thyroid Association guidelines. The data suggest that while practices changed and thyroid lobectomy became more frequent following the release of guidelines that allow for thyroid lobectomy, total thyroidectomy remained the most frequently performed procedure for these low-risk cancers.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Chi-square test / Dissection / Endocrine surgery / Female / Health risks / Humans / Hypocalcemia - epidemiology / Hypocalcemia - etiology / Hypoparathyroidism / Hypoparathyroidism - epidemiology / Hypoparathyroidism - etiology / Length of Stay - statistics & numerical data / Lymphatic system / Male / Medical prognosis / Middle Aged / Morbidity / Neck / Neoplasm Staging / Operative Time / Outcomes / Papillary thyroid cancer / Patients / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Practice Guidelines as Topic / Practice Patterns, Physicians' - standards / Practice Patterns, Physicians' - statistics & numerical data / Practice Patterns, Physicians' - trends / Quality control / Quality Improvement / Risk / Risk management / Software / Statistical analysis / Statistical tests / Subgroups / Surgery / Surgical oncology / Thyroid / Thyroid cancer / Thyroid Cancer, Papillary - diagnosis / Thyroid Cancer, Papillary - pathology / Thyroid Cancer, Papillary - surgery / Thyroid Gland - pathology / Thyroid Gland - surgery / Thyroid lobectomy / Thyroid Neoplasms - diagnosis / Thyroid Neoplasms - pathology / Thyroid Neoplasms - surgery / Thyroidectomy / Thyroidectomy - adverse effects / Thyroidectomy - methods / Thyroidectomy - standards / Thyroidectomy - trends / Treatment Outcome / Trends / Tumors / Variables / Variance analysis