Hemithyroidectomies becoming more popular treatment for malignant thyroid cancer
CHICAGO— Adults with thyroid cancer have been treated more frequently with hemithyroidectomy and are receiving fewer completion procedures, particularly after the 2015 update to the guideline from the American Thyroid Association, according to findings presented at the annual meeting of the American Thyroid Association.
“The ATA guidelines have had a measurable impact on the de-escalation of surgical therapy for thyroid nodules, and more demonstrably in the patients with malignant disease,” Vikas Mehta, MD, MPH, FACS, associate professor of otolaryngology/head and neck surgery at Montefiore Medical Center in the Bronx, New York, told Endocrine Today. “These changes have also coincided with a decrease in surgical complications and postoperative length of stay across the United States.”
Mehta and colleagues identified 131,481 adults with thyroid cancer who had a hemithyroidectomy, total thyroidectomy or completion thyroidectomy between 2005 and 2015 using data from the American College of Surgeons’ National Surgical Quality Improvement Program.
Between 2005 and 2009, 32.8% of individuals with thyroid cancer had a hemithyroidectomy compared with 31.4% between 2009 and 2015 and 34.9% between 2015 and 2017 (P < .001). The researchers noted that 24.2% of individuals with malignant thyroid cancer had a hemithyroidectomy after the 2015 guideline update made the threshold for the procedure a tumor size of less than 4 cm. Before this update, the threshold was less than 1 cm, and 16.6% of individuals with malignant thyroid cancer had a hemithyroidectomy.
The researchers further observed a 34% reduction in the “odds of having to return to the operating room for a complication” (OR = 0.66; 95% CI, 0.62-0.7) and an 87% increase in the likelihood of outpatient surgery (OR = 1.87; 95% CI, 1.84-1.9).
“The research demonstrates that these guidelines do impact practice in a quantifiable fashion, and people are understanding and embracing the concepts of de-escalation for thyroid cancer,” Mehta said. “The guidelines are important, and while possibly just coincidental, the decrease in the jump to a complete removal of the thyroid in the setting of thyroid cancer has led to improved outcomes for patients by decreasing surgical complications rates and length of stay.” – by Phil Neuffer
Mehta V, et al. Poster 61. Presented at: 89th Annual Meeting of the American Thyroid Association; Oct. 30-Nov. 3, 2019; Chicago.
Disclosure: Mehta reports no relevant financial disclosures.