Extent of surgery for low-risk thyroid cancer in the elderly: Equipoise in survival but not in short-term outcomes.
Extent of surgery for low-risk thyroid cancer in the elderly: Equipoise in survival but not in short-term outcomes.
复制标题
老年人低风险甲状腺癌的手术范围：生存率稳定，但短期结果不稳定。
DOI：
10.1016/j.surg.2019.05.035
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发表时间：
2019
期刊：
影响因子：
3.8
通讯作者：
Scheri,RandallP
中科院分区：
文献类型：
--
作者：
Zambeli-Ljepović,Alan;Wang,Frances;Dinan,MichaelaA;Hyslop,Terry;Stang,MichaelT;Roman,SanzianaA;Sosa,JulieA;Scheri,RandallP
尽管在生存率上势均力敌，但对于低风险的甲状腺乳头状癌，甲状腺全切除术比腺叶切除术更常见。由于术后发病率随着年龄的增长而增加，我们的目的是调查甲状腺切除术的程度如何影响老年patients.MethodsUsing的监测，流行病学，和最终结果-医疗数据库，我们确定了年龄≥66岁的患者谁是治疗乳头状甲状腺癌与肿瘤直径≤2厘米，在1996年和2011年之间。我们采用多变量Logistic回归分析，以评估手术的并发症，急诊科的访问，和计划外rearmissions.ResultsAmong 3,341选定的患者，77.3%是女性，平均年龄为72.9岁，肿瘤平均直径为0.8厘米的程度的影响。67.6%的患者接受了甲状腺全切除术，32.4%的患者接受了腺叶切除术。甲状腺全切除术与并发症（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（与白色患者相比，比值比= 1.65）和有≥2种合并症的患者（与0相比，比值比= 1.43;均P < 0.01）的并发症发生率较高。黑人患者和有≥2种合并症的患者有更多的急诊就诊（比值比分别为1.50和1.92）和再入院（比值比分别为2.19和2.29;均P < 0.01）。结论低危老年甲状腺乳头状癌患者行甲状腺全切除术可能导致潜在可避免的并发症和再入院，尤其是黑人和女性患者。在许多情况下，肺叶切除术可能是一种更安全，成本更低的选择。
BackgroundTotal 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.MethodsUsing 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.ResultsAmong 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; bothP< 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; allP< 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; allP< 0.01).ConclusionTotal 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.