Benefit From Treatment by High-Volume Surgeons in Advanced Papillary Thyroid Cancer?

August 1, 2018
John Schieszer
John Schieszer

Korean investigators concluded that, in terms of recurrence risk, a qualified high-volume surgeon may be optimal for performing the initial surgery in this setting.

Surgical volume matters when it comes to post-treatment recurrence of advanced papillary thyroid cancer. A team of Korean investigators found that the number of patients a thyroid surgeon treats may impact the risk of recurrence in the neck region.

The study, published in the British Journal of Surgery, demonstrated that surgical volume did not have an effect on cancer metastases or cancer-specific deaths in patients with advanced papillary thyroid cancer. However, the investigators found that, in terms of recurrence risk, a qualified high-volume surgeon may be the best choice for performing the initial surgery in this setting, decreasing the risk of recurrence during long-term follow-up.

Researchers from Sungkyunkwan University School of Medicine, Seoul, Korea, report that previous studies have shown that patients under the care of high-volume thyroid surgeons have fewer surgical complications. These patients also tend to have a shorter hospital stay and lower costs related to the thyroid surgery. However, the impact of the surgeon’s experience on long-term outcomes after thyroid cancer surgery has not been fully investigated, according to the researchers. For this investigation, they examined the impact of the surgeon volume on recurrence rates in patients with advanced thyroid cancer and metastasis of the cancer to the lymph nodes of the neck.

The study included 1,103 patients with papillary thyroid cancer and lateral neck lymph node metastases. All patients were treated between 1994 and 2011 and had undergone a total thyroidectomy with lateral neck lymph node dissection followed by radioactive iodine therapy. The patients were closely followed with blood thyroglobulin tests every 6 months and annual neck ultrasounds for a median follow-up of 81 months (range, 62–108 months).

The study included 26 surgeons who were divided in two groups: high-volume surgeons (those performing at least 100 operations a year) and low-volume surgeons (those performing fewer than 100 operations a year). The study showed annual patient volume was a more important factor for thyroid cancer recurrence than the number of years of practice by the surgeon. During the study period, 200 patients developed structural recurrence. The researchers adjusted for age, sex, and conventional risk factors for recurrence (histology, tumor size, gross extrathyroidal extension, margin status, more than five positive lymph nodes, and radioactive iodine therapy) and found that the adjusted HR for structural recurrence for low-volume surgeons was 1.46 compared with high-volume surgeons.

Overall, the researchers concluded that the number of years a surgeon was practicing was not nearly as important as annual patient volume when it came to curative outcomes and reduced treatment-related morbidity.