Does the surgeon’s experience matter when treating thyroid cancer?

 

Should you ask your surgeon how many thyroid operations they perform every year? The answer is “YES”. One of the most important factors leading to a good outcome after many types of major surgical procedures is the  experience of both the surgeon and the hospital in undertaking the procedure.  This has been well demonstrated for very major operations such as coronary artery bypass grafting or pancreatic resection, but only recently has the question of the treatment of thyroid cancer been addressed. Most general and ENT surgeons have had training in doing straightforward thyroid operations and may perform such procedures  well.  However the treatment of thyroid cancer requires special expertise in order to achieve complete clearance of all the cancer from the lymph glands in the neck and adequately remove all thyroid tissue whilst avoiding major complications.  Dr Sally Carty and her colleagues from the University of Pittsburgh recently published a study (see link below) showing that surgeons who perform more than 30 thyroid operations per year overall (ie for both benign nodules and cancer) are more likely to perform the correct operation for thyroid cancer and were more likely to get a good outcome. That was determined by measuring how much thyroid tissue had been left behind in the neck, as well as measuring tumour markers for thyroid cancer (serum thyroglobulin) and noting the number of subsequent treatments with radioactive iodine required. Surgeons performing more than 30 thyroidectomies per year performed better on all counts when treating thyroid cancer. For the treatment of advanced thyroid cancer, Carty recommended a cut-off of 50 thyroid operations per year.  Professor Delbridge personally performs more than  500 thyroid or parathyroid operations each year, and the University of Sydney Endocrine Surgical Unit treats more thyroid cancer each year than any other centre in Australia.