A cross-specialty survey to assess the application of risk stratified surgery for differentiated thyroid cancer in the UK

Abstract

INTRODUCTION This study describes variability of treatment for differentiated thyroid cancer among thyroid surgeons, in the context of changing patterns of thyroid surgery in the UK. METHODS Hospital Episodes Statistics on thyroid operations between 1997 and 2012 were obtained for England. A survey comprising six scenarios of varying 'risk' was developed. Patient/tumour information was provided, with five risk stratified or non-risk stratified treatment options. The survey was distributed to UK surgical associations. Respondent demographics were categorised and responses analysed by assigned risk stratified preference. RESULTS From 1997 to 2012, the Hospital Episode Statistics data indicated there was a 55% increase in the annual number of thyroidectomies with a fivefold increase in otolaryngology procedures and a tripling of cancer operations. Of the surgical association members surveyed, 264 respondents reported a thyroid surgery practice. Management varied across and within the six scenarios, and was not related consistently to the level of risk. Associations were demonstrated between overall risk stratified preference and higher volume practice (>25 thyroidectomies per year) (p=0.011), fewer years of consultant practice (p=0.017) and multidisciplinary team participation (p=0.037). Logistic regression revealed fewer years of consultant practice (odds ratio [OR]: 0.96/year in practice, 95% confidence interval [CI]: 0.922-0.997, p=0.036) and caseload of >25/year (OR 1.92, 95% CI: 1.044-3.522, p=0.036) as independent predictors of risk stratified preference. CONCLUSIONS There is a substantial contribution to thyroid surgery in the UK by otolaryngology surgeons. Adjusting management according to established case-based risk stratification is not widely applied. Higher caseload was associated with a preference for management tailored to individual risk.

Learning Curve for Transoral Endoscopic Thyroid Lobectomy

“…As a growing number of high-volume thyroid surgeons are otolaryngology–head and neck surgery trained, this is important to consider, as some authors postulated that the lack of laparoscopic experience is a potential barrier to adopting TOETVA within our field. 28,29 Our findings in this study do not necessarily support that notion. Evaluation of individual surgeons’ learning curves for TOETVA as stratified per prior laparoscopic experience will be invaluable in further defining this.…”

“…Although Anuwong et al did not statistically define a learning curve, the similarity to our findings may suggest that prior laparoscopic experience does not have a significant impact on the individualized learning curves for TOETVA. As a growing number of high‐volume thyroid surgeons are otolaryngology–head and neck surgery trained, this is important to consider, as some authors postulated that the lack of laparoscopic experience is a potential barrier to adopting TOETVA within our field 28,29 . Our findings in this study do not necessarily support that notion.…”