VANCOUVER, B.C. — Most thyroid cancer surgery is done by low-volume operators, who are less likely to perform a total thyroidectomy than are high-volume surgeons, Philip I. Haigh, M.D., reported at the annual meeting of the American Thyroid Association.
That being said, the issue of how extensive a thyroidectomy ought to be in well-differentiated thyroid cancer is a matter of some debate. There are no randomized controlled trials comparing total thyroidectomy versus less extensive resection, added Dr. Haigh of Kaiser Permanente Los Angeles Medical Center.
He reported on 3,679 consecutive patients with well-differentiated thyroid cancer who underwent thyroidectomy at the hands of 311 surgeons at 123 hospitals during 1993-2001.
Overall, 87% of the surgeons were low-volume operators, defined as those performing fewer than five thyroidectomies per year. Collectively, they did 39% of the thyroidectomies in this series. Moderate-volume surgeons—those averaging 5-19 cases per year—did 42% of the thyroidectomies. The three surgeons classified as high volume based upon performing 20 or more cases per year accounted for 19% of thyroidectomies.
The low-volume surgeons performed total thyroidectomies in 65% of patients. High volume surgeons did so in 71%, with moderate-volume surgeons having a total thyroidectomy rate similar to high-volume ones.
After statistical adjustment for tumor factors related to the appropriate extent of surgical resection, high- and moderate-volume surgeons were 40%-50% more likely to perform total thyroidectomy in patients with well-differentiated thyroid cancer than were low-volume surgeons.
Men were significantly more likely than women to undergo total thyroidectomy in this study. Dr. Haigh and his coinvestigators had hypothesized that surgeons at urban teaching hospitals would perform total thyroidectomy in significantly more of their patients than would surgeons practicing in other settings, but in fact the rates turned out to be very similar.