BACKGROUND
Thyroid cancer is usually initially treated by surgery. This can either be a lobectomy (removal only the thyroid lobe containing the cancer) or a total thyroidectomy (removal of the entire thyroid). Given the excellent prognosis of thyroid cancer, in recent years thyroid experts, high volume thyroid surgeons and national guidelines have recommended for a ‘less is more’ approach to thyroid cancer surgery. This means doing a lobectomy as opposed to a total thyroidectomy for low risk thyroid cancers, which are identified by being small (<4 cm), confined to the thyroid gland and no evidence for spread to the outside the thyroid to the lymph nodes in the neck. However, much of thyroid surgery in the US is performed by low volume surgeons, which may not be aware of newer guidelines and/or may not have the experience or knowledge of the disease to adapt this newer approach. Therefore, the authors of the study surveyed surgeons across the country that had performed thyroid surgery in recent years to examine their attitudes and performance of type of surgery for low risk thyroid cancer.

THE FULL ARTICLE TITLE
McDow AD et al 2021 Thyroid lobectomy for low-risk papillary thyroid cancer: A national survey of low- and high-volume surgeons. Ann Surg Oncol.

SUMMARY OF THE STUDY
A survey was made available to 1500 actively practicing physicians. Of these, 33.3% responded and 320 were analyzed (because the rest were not from currently practicing surgeons performing thyroidectomy). The responses were from 150 general surgeons (46.9%) and 170 otolaryngologists (ears, nose and throat surgeons) (53.1%).

Surgeons were given various clinical cases and asked what surgery they would perform and their beliefs of different surgerys. Low–volume surgeons were defined as doing <25 operations per year and 64% of those that responded were categorized as low-volume surgeons. They were much less likely to recognize that a lobectomy was supported by current guidelines and evidence for treatment of thyroid cancer. High volume surgeons reported that thyroid lobectomy was under-utilized, but most reported they would still perform a total thyroidectomy instead of lobectomy for a low risk cancer.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Knowledge and translation of updated guidelines is poor, meaning that thyroid experts are doing a poor job educating all potential surgeons performing thyroid surgery in the community about updates in the treatment of low risk thyroid cancer. This is important for patients to understand that the surgeon’s recommendation of treatment may be based on personal experience and not updated knowledge or current updated national guidelines and studies. Most importantly, patient’s needs to be their own advocates. The best course of action would be to consult with a high volume surgeon, but that is not always possible, and this study shows that many of them also have their only ideas based on their personal experiences. Therefore, the patient may also need to take it upon themselves to ask questions and self-educate as best as possible the options available to them.

— Melanie Goldfarb, MD

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