Department of Surgery, Duke University Medical Center, Durham, NC.
Department of Surgery, University of California at San Fransisco, San Francisco, CA.
Surgery. 2019 Nov;166(5):895-900. doi: 10.1016/j.surg.2019.05.035. Epub 2019 Jul 6.
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.
尽管在生存方面无差异，但对于低危型甲状腺乳头状癌，全甲状腺切除术比叶切除术更为常见。由于术后发病率随年龄增长而增加，我们旨在研究甲状腺切除术的范围如何影响老年患者的短期结局。
我们使用监测、流行病学和最终结果-医疗保险数据库，确定了 1996 年至 2011 年间接受肿瘤直径≤2cm 的甲状腺乳头状癌治疗的年龄≥66 岁的患者。我们使用多变量逻辑回归评估手术范围对并发症、急诊就诊和非计划性再入院的影响。
在选定的 3341 名患者中，77.3%为女性，平均年龄为 72.9 岁，肿瘤平均直径为 0.8cm。共有 67.6%的患者接受了全甲状腺切除术，32.4%的患者接受了叶切除术。全甲状腺切除术与并发症（比值比=1.99）和再入院（比值比=1.59；均 P<0.01）相关。女性患者（比值比=1.34）、黑人患者（与白人患者相比，比值比=1.65）和合并症≥2 种的患者（与无合并症患者相比，比值比=1.43；均 P<0.01）并发症发生率更高。黑人患者和合并症≥2 种的患者急诊就诊（比值比=1.50 和 1.92）和再入院（比值比=2.19 和 2.29；均 P<0.01）的可能性更高。
对于低危型甲状腺乳头状癌的老年患者，全甲状腺切除术可能导致潜在可避免的并发症和再入院，尤其是对于黑人患者和女性患者。在许多情况下，叶切除术可能是一种更安全、成本更低的替代方法。
