SAFETY AND LONG-TERM RESULTS OF THYROID CANCER SURGERY IN RELATION TO SURGEON’S EXPERIENCE

Surgeon’s and hospital’s annual volume is a factor associated with lower postoperative morbidity and mortality for many complex surgical procedures, including cancer operations and thyroid surgery. Specifically regarding thyroid surgery, when it is performed by high-volume surgeons, iatrogenic injury of the recurrent laryngeal nerve and postoperative hypoparathyroidism occur with less frequency. Moreover, surgeon’s experience (measure by annual volume) is associated with a better long-term prognosis for patients with thyroid cancer, probably as a result of a more radical and appropriate initial surgery. In a recent study by  Kim et al (2018), patients who had surgery by a high-volume surgeon (annual case volume ≥ 100) were more likely to be more advanced cases with gross extrathyroidal extension compared with patients who were operated by less experienced surgeons (33 % vs. 25 %, respectively), and less likely to have a positive resection margin (9 % vs. 18 %). Moreover, local recurrence rates were lower when thyroid cancer was performed by high-volume surgeons (15 % vs. 27 %). (* the study by Kim et al [see below] refers to patients with differentiated thyroid cancer and known lateral lymph node metastases at the time of initial surgery).

The problem of local recurrence is important since reoperation is typically required, and the operative risk is increased in a scarred field (thereby increasing morbidity). Moreover, the burden and cost of thyroid cancer treatment is significantly increased.

*Kim HI, Kim TH, Choe JH, Kim JH, Kim JS, Kim YN, Kim H, Kim SW, Chung JH 2018 Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis. Br J Surg 105:270-278.