Abstract
Background
The 2015 American Thyroid Association guidelines endorsed lobectomy for patients with low-risk papillary thyroid cancer (PTC) measuring 1–4 cm. Attitudes about the use of lobectomy for these patients are lacking, particularly from low-volume surgeons who perform the majority of thyroidectomies in the US.
Methods
A survey was mailed to 1000 surgeons stratified by specialty (500 general surgeons and 500 otolaryngologists) registered with the American Medical Association, to evaluate beliefs and practices about the extent of surgery for low-risk PTC. Comparisons examined differences by surgeon volume.
Results
Of 320 respondents who have performed thyroidectomy since 2015 (150 general surgeons, 170 otolaryngologists), 206 (64.4%) were low volume (< 26 thyroidectomies/year). The proportion of surgeons recommending lobectomy for low-risk PTC measuring 1.1 to < 4 cm ranged from 43.1 to 2.6%. High-volume surgeons recommended lobectomy more frequently for PTC measuring 1.1–3 cm, although this was not statistically significant. Thirty-three percent of respondents believed lobectomy is underused for low-risk PTC, while 10.0% believed it is overused. Additionally, 19.6% of respondents believed recurrence is more likely after lobectomy than total thyroidectomy, and 3.3% believed mortality is higher. Few believed quality of life is better after lobectomy (12.3%). Low-volume surgeons were less likely to be aware guidelines support lobectomy for low-risk PTC 1–4 cm (p < 0.001) and less likely to use clinical practice guidelines (p = 0.004).
Conclusions
Most surgeons do not support lobectomy for patients with low-risk PTC > 1 cm. Awareness of guidelines and concerns about increased risk of recurrence after lobectomy may drive surgeons’ preference for total thyroidectomy.
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Acknowledgment
This study was funded by the University of Wisconsin Carbone Cancer Center Support Grant P30 CA014520. Dr. Pitt is supported by the National Cancer Institute of the National Institutes of Health (NIH) award number K08CA230204. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. In addition, the NIH did not play a role in the design or conduct of the study; data collection, management, analysis or interpretation; manuscript preparation, review, or approval; and decision to submit the manuscript for publication. The authors would like to acknowledge Margarete Wichman, PhD, Griselle Sanchez-Diettert, BA, and Kelly M. Elver, PhD, from the University of Wisconsin Survey Center for their assistance with survey preparation and critical review.
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McDow, A.D., Saucke, M.C., Marka, N.A. et al. Thyroid Lobectomy for Low-Risk Papillary Thyroid Cancer: A National Survey of Low- and High-Volume Surgeons. Ann Surg Oncol 28, 3568–3575 (2021). https://doi.org/10.1245/s10434-021-09898-9
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DOI: https://doi.org/10.1245/s10434-021-09898-9