MON-567 Is Over Diagnosis Of Thyroid Cancer In A Non-high-income Country Impacting The Outcome Of Thyroid Cancer Surgery. An Assessment Of Surgical Outcomes In A Thyroid Cancer Referral Center In Ecuador

Abstract

The frequency of thyroid surgeries has increased proportionality to the increment incidence of thyroid cancer. Yet, the number of experienced thyroid surgeons has not raised accordingly to that of thyroid cancer incidence. As a result, many thyroid surgeries are conducted by low volume surgeons that might affect the risk of surgical complications and remaining postoperative thyroid tissue. These poor surgical outcomes might be higher among countries affected by more thyroid cancer diagnosis yet with limited thyroid surgical expertise such as in a resource limited setting as Ecuador. The purpose of this study is to assess the outcomes of thyroid cancer surgery in a referral thyroid cancer center in Ecuador, and to explore the risk factors associated with poor surgical outcomes. Methods Around 344 patients with non-metastatic differentiated thyroid undergoing initial thyroid surgery (total thyroidectomy, central neck dissection) for a primary tumor were identified from an institutional database, and treated between June 1st, 2014 to December 31st, 2017. Poor surgical outcome was described in patients experience any surgical complications (recurrent laryngeal injury assessed with laryngoscopy and postoperative temporary and permanent hypoparathyroidism) or a stimulated post-operative Tg> 2mg/dL. Results Of the 344 patients, 127 patients had surgical complication and post-operative stimulated Tg data available to analyze. From this cohort, 22 (17%) patients had surgical complications, 19 (15%) hypoparathyroidism ( 8% temporary and 7% permanent) and 5 (4%) recurrent laryngeal nerve injury. A total of 74 (58%) out of 127 patients had a sTg value higher than 2 ng/ml. A poor surgical outcome was present in 88 (64%) patients. The multivariate analysis showed that the factor that was independently associated with poor surgical outcome was tumor size ≥1cm (OR: 3.3, 95% CI 1.18 - 9.3). Sex, age at diagnosis, benign non-nodular thyroid disease, BMI, place of surgery, tumor focallity, histology, extra thyroid extension variables were not- associated with poor surgical outcomes. Conclusion Two thirds of thyroid cancer surgeries, assessed in an Ecuadorian thyroid cancer referral center, had a poor surgical outcome that may lead to low patient’s low quality of life, and the need for additional treatment strategies. These estimates are higher than what is reported from the literature and suggest that the overdiagnosis of thyroid cancer in non-high-income country income countries might result in worse surgical outcomes.