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Surgical Case Volume has an Impact on Outcomes for Patients with Lateral Neck Disease in Thyroid Cancer

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to assess whether surgical case volume for lateral neck dissection has an impact on the survival of patients who have well-differentiated thyroid cancer (WDTC) with lateral cervical node metastases. The authors used a population-based cohort study design.

Methods

The study cohort consisted of WDTC patients in Ontario Canada who underwent thyroidectomy and lateral neck dissection. These patients were identified using both hospital- and surgeon-level administrative data between 1993 and 2017 (n = 1832). Surgeon and hospital volumes were calculated based on the number of cases managed in the year before the procedure by the physician and at the institution managing each case, respectively, and divided into tertiles. Multilevel Cox regression models were used to estimate the effect of volume on disease-free survival (DFS).

Results

A crude model without patient or treatment characteristics demonstrated that DFS was associated with both higher surgeon volume tertiles (p < 0.01) and higher hospital volume tertiles (p < 0.01). After control for clustering, patient/treatment covariates, and hospital volume, the lowest surgeon volume tertile (range, 0–20/year; mean, 6.5/year) remained an independent statistically significant negative predictor of DFS (hazard ratio, 1.71; 95 % confidence interval, 1.22–2.4; p < 0.01).

Conclusion

Surgeon lateral neck dissection case volume is a predictor of better DFS for thyroid cancer patients, with the lowest surgeon volume tertile (<20 neck dissections per year) demonstrating poorer DFS.

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Acknowledgments

This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. Parts of this material are based on data and information provided by CCO and the Canadian Institute for Health Information (CIHI). We thank Immigration, Refugees and Citizenship Canada (IRCC) for providing access to the database used in this study. We also thank Service Ontario for the use of the Office of the Registrar General for information on deaths. The analyses, conclusions, opinions, and statements reported in this article are those of the authors and do not necessarily reflect those of CCO or CIHI. No endorsement by the ICES or the MOHLTC or CCO or CIHI is intended or should be inferred. We acknowledge Dr. Jiming Fang at ICES Central for assisting in statistical design.

Author information

Authors and Affiliations

  1. Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, ON, Canada

    Jennifer Siu MD, MPH, Christopher W. Noel MD, Eric Monteiro MD, MSc, FRCSC, David P. Goldstein MD, MSc, FACS, FRCSC, Jonathan C. Irish MD, MSc, FACS, FRCSC & Antoine Eskander MD, ScM, FRCSC

  2. ICES, Toronto, ON, Canada

    Jennifer Siu MD, MPH, Rebecca Griffiths BSc, Christopher W. Noel MD, Peter C. Austin PhD & Antoine Eskander MD, ScM, FRCSC

  3. Cancer Care and Epidemiology, Queens University, Kingston, ON, Canada

    Rebecca Griffiths BSc

  4. Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada

    Christopher W. Noel MD, Peter C. Austin PhD & Antoine Eskander MD, ScM, FRCSC

  5. Department of Surgery, Division of General Surgery/Surgical Oncology, University of Toronto, University Health Network, Toronto, ON, Canada

    Jesse Pasternak MD, MPH, FRCSC

  6. Womens College Hospital and Departments of Surgery and Health Policy, Management and Evaluation, Womens College Research Institute, University of Toronto, Toronto, ON, Canada

    David Urbach MD

  7. Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Eric Monteiro MD, MSc, FRCSC, David P. Goldstein MD, MSc, FACS, FRCSC & Jonathan C. Irish MD, MSc, FACS, FRCSC

  8. Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada

    Anna M. Sawka MD, PhD, FRCPC

  9. Department of Otolaryngology–Head and Neck Surgery, Surgical Oncology, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, ON, Canada

    Antoine Eskander MD, ScM, FRCSC

Authors
  1. Jennifer Siu MD, MPH
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  2. Rebecca Griffiths BSc
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  3. Christopher W. Noel MD
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  4. Peter C. Austin PhD
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  5. Jesse Pasternak MD, MPH, FRCSC
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  6. David Urbach MD
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  7. Eric Monteiro MD, MSc, FRCSC
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  8. David P. Goldstein MD, MSc, FACS, FRCSC
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  9. Jonathan C. Irish MD, MSc, FACS, FRCSC
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  10. Anna M. Sawka MD, PhD, FRCPC
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  11. Antoine Eskander MD, ScM, FRCSC
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Corresponding author

Correspondence to Antoine Eskander MD, ScM, FRCSC.

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Disclosure

Dr. Eskander received research funds from Merck and was a paid consultant for Bristol-Myers. Dr. Noel receives salary support through a CIHR Doctoral Award, an Ontario Ministry of Health Clinician Investigator Award, an Ontario Graduate Scholarship, the Chapnik Freeman Friedberg Clinician Scientist Award, the Raymond H.W. Ng PhD Scholarship, and the Waratah Hold’em for Life Oncology Fellowship. Dr. Eskander also is supported by a Terry Fox Research Institute New Investigator Grant. Dr. Siu receives support through the Chapnik Freeman Friedberg Clinician Scientist Award. Dr. Austin is supported by a Mid-Career Investigator Award from the Heart and Stroke Foundation.

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Siu, J., Griffiths, R., Noel, C.W. et al. Surgical Case Volume has an Impact on Outcomes for Patients with Lateral Neck Disease in Thyroid Cancer. Ann Surg Oncol 29, 1141–1150 (2022). https://doi.org/10.1245/s10434-021-10923-0

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