Extent of surgery for low-risk thyroid cancer in the elderly: Equipoise in survival but not in short-term outcomes

• Published in: Surgery 2019-11, Vol.166 (5), p.895-900
• Main Authors: Zambeli-Ljepović, Alan, Wang, Frances, Dinan, Michaela A., Hyslop, Terry, Stang, Michael T., Roman, Sanziana A., Sosa, Julie A., Scheri, Randall P.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Male; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - etiology; SEER Program - statistics & numerical data; Sex Factors; Survival Analysis; Thyroid Cancer, Papillary - mortality; Thyroid Cancer, Papillary - pathology; Thyroid Cancer, Papillary - surgery; Thyroid Gland - pathology; Thyroid Gland - surgery; Thyroid Neoplasms - mortality; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy - adverse effects; Thyroidectomy - methods; Treatment Outcome; United States - epidemiology
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2019.05.035

Total thyroidectomy is more common than lobectomy for low-risk papillary thyroid cancer, despite equipoise in survival. Because postoperative morbidity increases with age, we aimed to investigate how the extent of thyroidectomy affects short-term outcomes among older patients. Using the Surveillance, Epidemiology, and End Results–Medicare database, we identified patients aged ≥66 years who were treated between 1996 and 2011 for papillary thyroid cancer with tumors ≤2 cm in diameter. We used multivariable logistic regression to evaluate the effect of extent of surgery on complications, emergency-department visits, and unplanned readmissions. Among 3,341 selected patients, 77.3% were female, mean age was 72.9 years, and tumors averaged 0.8 cm in diameter. A total of 67.6% of patients underwent total thyroidectomy, and 32.4% underwent lobectomy. Total thyroidectomy was associated with complications (odds ratio = 1.99) and readmissions (odds ratio = 1.59; both P < 0.01). Complications were higher in female patients (odds ratio = 1.34), black patients (versus white patients, odds ratio = 1.65), and those with ≥2 comorbidities (vs 0, odds ratio = 1.43; all P < 0.01). Black patients and those with ≥2 comorbidities had more emergency-department visits (odds ratio = 1.50 and 1.92, respectively) and readmissions (odds ratio = 2.19 and 2.29, respectively; all P < 0.01). Total thyroidectomy for older adults with low-risk papillary thyroid cancer may lead to potentially avoidable complications and readmissions, particularly for black and female patients. In many cases, lobectomy may be a safer and less costly alternative.