Surgery alone for papillary thyroid microcarcinoma is less costly and more effective than long term active surveillance

Jia F. Lin, Pascal K. C. Jonker, Michelle Cunich, Stanley B. Sidhu, Leigh W. Delbridge, Anthony R. Glover, Diana L. Learoyd, Ahmad Aniss, Schelto Kruijff, Mark S. Sywak*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

18 Citations (Scopus)

Abstract

Background: Papillary thyroid microcarcinoma is a subtype of thyroid cancer that may be managed with active surveillance rather than immediate surgery. Active surveillance decreases complication rates and may decrease health care costs. This study aims to analyze complication rates of thyroid surgery, papillary thyroid microcarcinoma recurrence, and survival rates. Additionally, the costs of surgery versus hypothetic active surveillance for papillary thyroid microcarcinoma are compared in an Australian cohort. Methods: Papillary thyroid microcarcinoma patients were included from a prospectively collected surgical cohort of patients treated for papillary thyroid cancer between 1985 and 2017. The primary outcomes were the complications of thyroid surgery, recurrence-free survival, overall survival, and cost of surgical treatment and active surveillance. Results: In a total of 349 patients with papillary microcarcinoma with a median age of 48 years (range, 18–90 years), the permanent operative complications rate was 3.7%. Postoperative radioactive iodine did not decrease recurrence-free survival (P = .3). The total cost of surgical treatment was $10,226 Australian dollars, whereas hypothetic active surveillance was at a yearly cost of $756 Australian dollars. Estimated cost of surgical papillary thyroid microcarcinoma treatment was equivalent to the cost of 16.2 years of active surveillance. Conclusion: Surgery may have a long-term economic advantage for younger Australian patients with papillary thyroid microcarcinoma who are likely to require more than 16.2 years of follow-up in an active surveillance scheme.

Original languageEnglish
Pages (from-to)110-116
Number of pages7
JournalSurgery
Volume167
Issue number1
DOIs
Publication statusPublished - Jan-2020
Event40th Annual Meeting of the American-Association-of-Endocrine-Surgeons (AAES) - Los Angeles, Canada
Duration: 7-Apr-20199-Apr-2019

Keywords

  • RADIOACTIVE IODINE ABLATION
  • ASSOCIATION GUIDELINES
  • MANAGEMENT
  • COMPLICATIONS
  • RECURRENCES
  • METASTASIS
  • CANCER
  • IMPACT
  • RISK

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