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Surgical management of low-risk papillary thyroid cancer in real life in Spain: a nationwide survey of endocrine neck surgeons and endocrinologists

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Abstract

Background

The extent of surgery in patients with papillary thyroid cancer (PTC) is a subject of ongoing debate. We aimed to explore the attitude of Spanish specialists (endocrinologists, surgeons, and otolaryngologists) in real life on the surgical management of low-risk PTC.

Methods

We designed an anonymous, web-based survey to inquire information regarding the preferences of interviewees for hemithyroidectomy (Hem), total thyroidectomy (TT) and prophylactic central neck dissection (pCND) in one standard patient with PTC and six clinical variants. We differentiated between small (1.1–2.5 cm) and large (2.6–4.0 cm) tumors.

Results

A total of 278 valid responses were received and divided into two groups: group END (n = 135) and group SUR (n = 143, 101 general surgeons and 42 otolaryngologists). The preference for Hem was low in the standard patient and similar between both groups (40.6 vs 49.0%, NS). This preference decreased for tumors measuring 2.6–4.0 cm, multifocal, with risk location, family history of thyroid cancer, or history of irradiation, and increased in patients older than 65 years or with comorbidity. Preference for pCND ranged from 12.6–71.1% in the group END and from 22.4–65.0% in the group SUR, with few differences between the two. In multivariate analysis, being a high-volume specialist was associated with a lower preference for Hem, while having private practice was associated with a more favorable opinion of Hem.

Conclusion

The real clinical practice of Spanish specialists is far from what is recommended by the clinical guidelines in patients with low-risk PTC, especially among high-volume professionals.

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Data availability

Data are available through a reasonable request to the corresponding author.

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Acknowledgements

We thank SEEN, endocrine surgery section of the AEC and SEORL-CCC who endorsed our survey and assisted its dissemination and all members of these societies who took the time to complete the survey.

Author contributions

Conception and design: J.J.D.; administrative support, provision of study materials, collection and assembly of data, data analysis and interpretation: all authors. Manuscript writing of the first draft: J.J.D.; final approval of manuscript: all authors.

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Authors and Affiliations

  1. Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain

    Juan J. Díez

  2. Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    Juan J. Díez

  3. Department of Otorhinolaryngology, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain

    Pablo Parente

  4. Department of General Surgery, King Juan Carlos University Hospital, Madrid, Spain

    Manuel Durán-Poveda

  5. Department of Medical Specialties and Public Health, Faculty of Health Sciences King Juan Carlos University, Madrid, Spain

    Manuel Durán-Poveda

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  1. Juan J. Díez
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Correspondence to Juan J. Díez.

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Díez, J.J., Parente, P. & Durán-Poveda, M. Surgical management of low-risk papillary thyroid cancer in real life in Spain: a nationwide survey of endocrine neck surgeons and endocrinologists. Endocrine 83, 422–431 (2024). https://doi.org/10.1007/s12020-023-03488-3

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