Alternative Access Versus Conventional Open Thyroidectomy: National Trends
Posted: Wednesday, April 8, 2020
Although alternative access thyroidectomy techniques are becoming more common for treating thyroid cancer than conventional open thyroidectomy techniques in the United States, short-term outcomes between the two procedures seem to be comparable. Elizabeth Lancaster, MD, of the University of California San Francisco, and colleagues, reported that this new technique appears to be performed in low-volume centers and for more advanced disease. The study was presented at the 2019 American Thyroid Association Annual Meeting (Oral Abstract 37) and published in the journal Thyroid.
Using the National Cancer Database, the researchers analyzed 216,520 patients who underwent alternative access thyroidectomy versus conventional open thyroidectomy for thyroid cancer. Alternative access thyroidectomy procedures increased linearly over time between 2010 and 2016. Procedures were performed endoscopically (n = 3,385) or robotically (n = 742). Of the 739 centers that had alternative access procedures, the majority of centers (87%) performed fewer than 10 cases for thyroid cancer. Patients undergoing alternative access thyroidectomies were significantly more likely to have more advanced disease (P < .01) and tumors smaller than 4 cm (P = .01) than patients undergoing conventional procedures. Patients who received alternative access surgery were also more likely to have clinically positive lymph nodes (P < .01) and metastatic disease (P < .01).
The investigators observed lower overall survival among patients who received alternative access thyroidectomies than those who underwent a conventional procedure at the beginning of the study period (2010–2013). However, there was no difference in overall survival in subsequent years. Between the two procedures, there were no differences in positive surgical margins, readmission, or early mortality.
Disclosure: Full disclosures of the study authors can be found at thyroid.org.