MedicalResearch.com Interview with:
Megan Rist Haymart MD
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Thyroid cancer is typically treated with thyroid surgery. It is common practice for physicians to inform patients that the risk of vocal cord paralysis or hypoparathyroidism with thyroid surgery is 1-3%.
However, most of these estimates are based on single institution studies with high volume surgeons. In our study we evaluated surgical risks in a population-based cohort. Using the Surveillance, Epidemiology, and End Results-Medicare database, we found that 6.5% of thyroid cancer patients developed general post-operative complications (fever, infection, hematoma, cardiopulmonary and thromboembolic events) and 12.3% developed thyroid surgery specific complications (hypoparathyroidism/hypocalcemia, vocal cord/fold paralysis).
Older patient age, presence of comorbidities, and advanced stage disease were associated with the greatest risks of surgical complications.
MedicalResearch.com: What should readers take away from your report?
Response: When making treatment decisions, it is important to balance benefits-risks. It is also important for patients to be informed. This study suggest that the risks from surgery for thyroid cancer is higher than expected. This should factor into treatment decision-making. Although our study did not evaluate surgeon volume, prior work has illustrated the relationship between high surgical volume and lower complication rates. Therefore, for patients at higher risk of complications, referral to high-volume surgeons may be optimal.
In addition, efforts to effectively train low-volume surgeons in order to adopt best-practice strategies, decrease practice variation, and implement prompt recognition and management of post-operative complications are needed.
Finally, given the risks, in select patients such as those with low-risk thyroid cancer, less aggressive surgical approaches may be appropriate.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Efforts to reduce the rate of surgical complications are needed. This may require physician education and/or interventions to improve referral to high-volume surgeons.
MedicalResearch.com: Is there anything else you would like to add?
Response: From a patient perspective, permanent hypoparathyroidism and permanent vocal cord paralysis are not trivial complications. Patients with permanent hypoparathyroidism require medications multiple times a day. Missing their medications can result in severe low calcium levels with risk for hospitalization and rarely seizures. Vocal cord paralysis can result in a hoarse/raspy voice that can impair social and work interactions. These long-term complications can be very troublesome for patients.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Maria Papaleontiou, David T. Hughes, Cui Guo, Mousumi Banerjee, Megan R. Haymart. Population-Based Assessment of Complications following Surgery for Thyroid Cancer. The Journal of Clinical Endocrinology & Metabolism, 2017; DOI: 10.1210/jc.2017-00255
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