Children requiring thyroid surgery have better outcomes at high-volume surgery centers

April 04, 2019

Philadelphia, April 4, 2019 -- New research recently published in the Journal of Pediatric Surgery found that post-operative success rates of pediatric thyroid patients, particularly children who require a thyroidectomy, correlate with the institution's patient volume. The study, conducted by a team at Children's Hospital of Philadelphia (CHOP), reviewed nearly 500 cases. The findings underscore how a highly experienced clinical team can make a big difference when it comes to patient outcomes.

Since thyroid disease is less common in children than adults, pediatric surgery specialists often have less experience in managing thyroid disease. Other studies have reported an increased risk of complications for children undergoing thyroid surgery, with patients about 3.5 times more likely than adults to be readmitted and receive care that does not conform to national guidelines. For many patients, surgery is often a necessity, as is the case for patients with thyroid cancer where surgical removal of the thyroid and regional lymph nodes is the most important initial step in care after the diagnosis is confirmed by fine needle aspiration biopsy. Surgery is also commonly performed for patients with Graves' disease, an autoimmune disorder that causes hyperthyroidism (overactive thyroid), since less than 30 percent of pediatric patients with Graves' disease achieve remission.

"The Pediatric Thyroid Center at CHOP is the busiest center of its kind in the United States," said N. Scott Adzick, MD, Surgeon-in-Chief of CHOP and senior author of the study. "Our highly skilled team performs at least 80 thyroid surgeries each year, along with the evaluation and management of care for hundreds of patients. We wanted to measure the advantages of being in a high-volume center and examine what that means for patient outcomes both before and after surgery."

The study team reviewed medical records of 464 pediatric patients undergoing thyroid surgery at CHOP between 2009 and 2017. Data collection focused on pathologic diagnosis, surgical technique, and surgical complications. The patients were diagnosed with papillary or follicular thyroid cancer (n=168), benign modules (n=151), Graves' disease (n=124), medullary thyroid cancer (n=14), and seven patients underwent a prophylactic thyroidectomy for multiple endocrine neoplasia, type 2A (MEN2a), which is characterized by medullary carcinoma of the thyroid. Surgery for papillary thyroid cancer included lymph node dissections based on the extent of disease.

Complication rates after thyroidectomy in 464 pediatric patients are the lowest ever reported. Only two patients demonstrated a persistent recurrent laryngeal nerve deficit at 6 months postoperatively (0.4%), and two patients had persistent hypoparathyroidism 6 months after total thyroidectomy (0.6%). There was no significant difference in either hypocalcemia or hypoparathyroidism after total thyroidectomy based on the patient's age or diagnosis.

"We reported extremely low complication rates after surgery, underscoring that a high-volume center with specialized pediatric surgeons well-versed in these procedures should be considered for children and adolescents who require surgery for thyroid disease," said Andrew J. Bauer, MD, an endocrinologist and Medical Director of the Pediatric Thyroid Center at CHOP and one of the co-authors of the study. "By seeing a higher volume of patients, our team is extremely skilled at ensuring an accurate and complete pre-operative evaluation, and selecting the best surgical plan for each patient based on their diagnosis. This approach is associated with optimizing outcomes while at the same time reducing complications for our patients and families."
-end-
Baumgarten et al, "Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center." J Pediatr Surg, online Feb. 28, 2019. doi.org/10.1016/j.jpedsurg.2019.02.009.

About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 564-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu

Children's Hospital of Philadelphia

Related Thyroid Cancer Articles from Brightsurf:

Trends in the global burden of thyroid cancer
This study examined the worldwide trends of thyroid cancer from 1990 to 2017 according to geographic location, sex, age and socioeconomic factors.

Cancer treatment with immune checkpoint inhibitors may lead to thyroid dysfunction
Thyroid dysfunction following cancer treatment with new treatments called immune checkpoint inhibitors is more common than previously thought, according to research that was accepted for presentation at ENDO 2020, the Endocrine Society's annual meeting, and will be published in a special supplemental section of the Journal of the Endocrine Society.

Thyroid cancer, genetic variations, cell phones linked in YSPH study
Radiation from cell phones is associated with higher rates of thyroid cancer among people with genetic variations in specific genes, a new study led by the Yale School of Public Health finds.

AJR researchers take step toward automating thyroid cancer triage
An article published ahead-of-print in the April issue of the American Journal of Roentgenology (AJR) details how a Stanford University team developed a quantitative framework able to sonographically differentiate between benign and malignant thyroid nodules at a level comparable to that of expert radiologists, which could provide second-opinion malignancy risk estimation to clinicians and ultimately help decrease the number of unnecessary biopsies and surgical procedures.

Thyroid cancer rates in US
An analysis suggests rates of thyroid cancer in the US appear to have plateaued in recent years after decades on the rise.

Using artificial intelligence to predict risk of thyroid cancer on ultrasound
New study uses machine learning on ultrasound images of thyroid nodules to predict risk of malignancy.

For low-risk thyroid cancer patients, less may be more for post-surgery surveillance
Patient self-advocacy is important, and although a maximizing preference may be advantageous in many situations, new research led by the University of Michigan Rogel Cancer Center shows that, in the case of long-term surveillance of treated, low-risk thyroid cancer, health care ''maximizers'' consume more health care resources -- such as doctor visits and diagnostic imaging tests -- which drive up costs without a clear improvement in outcomes.

New test for thyroid cancer could prevent unnecessary surgery
Each year, thanks to inconclusive tests for thyroid cancer, thousands of people undergo unnecessary surgeries to remove part or all of their thyroids.

Raman spectroscopy poised to make thyroid cancer diagnosis less invasive
Researchers have demonstrated that an optical technique known as Raman spectroscopy can be used to differentiate between benign and cancerous thyroid cells.

Are doctors treating more thyroid cancer patients than necessary?
New research may help change treatment practices for patients diagnosed with low risk thyroid cancer.

Read More: Thyroid Cancer News and Thyroid Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.