Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P56

Endocrine

P56		
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
November 2017 were included. Data on demographics, US
complication. Other factors, such as resident turnover, could
features, cytology, and surgical histology were collected.
be explored as contributing factors in the future.
Results: A total of 4988 nodules were included, 4425 of
which were <4 cm and 563 that were ≥4 cm. For nodules
Endoscopic and Robotic-Assisted Surgery
≥4 cm, FNAC had an FN rate of 6.59%, compared with 4.22%
for Thyroid Cancer: A National Cancer
in nodules <4 cm. On FNAC, there was a larger proportion of
Database Analysis
Bethesda III and IV in large nodules. Although the malignancy
Rushi Patel (Presenter); Meet Patel; Gregory L.
rate was similar in nodules <4 cm and ≥4 cm (4.4% vs 4.3%,
Barinsky, PharmD; Dongmin C. Kim; Soly Baredes, MD;
respectively,
P = .914), there was a higher proportion of folRichard C. Park, MD
licular and Hurthle cell carcinomas in larger nodules (25% and
Objectives: To analyze differences in patient demographics,
16.7%, compared with 5.7% and 1.6% in nodules <4 cm).
clinicopathologic characteristics, and survival among open,
Larger nodules tended to have more suspicious features on US.
endoscopic, and robotic-assisted thyroid cancer surgery.
Conclusions: Larger nodules ≥4 cm have a similar rate of
Methods: The National Cancer Database was queried for all
malignancy to smaller nodules. There is a higher proportion of
cases of noninvasive, nonmetastatic thyroid cancer from 2010
Bethesda III and IV cytologies and follicular and Hurthle cell
to 2015. Cases were divided into open, endoscopic, and roboticcarcinomas in large nodules. Although the FN rate for nodules
assisted cohorts. Demographics, clinicopathological features,
≥4 cm is slightly higher at 6.6%, there is no conclusive eviand survival rates were examined. Survival was analyzed using
dence that surgery should be routinely performed in these
Kaplan-Meier analysis and Cox proportional hazards.
patients. US features may be useful in differentiating the nodResults: A total of 90,694 patients were included, of whom
ules ≥4 cm that warrant surgery.
most were female (77.5%), white (85.2%), and aged between
0 and 59 years (71.3%). There was no significant difference in
Multi-database Analysis of Neck Dissection
survival between open (n = 89,041; reference), endoscopic
Surgeon Volume and Complication Rates in
(n = 1306; odds ratio [OR] = 1.116, P = .462), or robotic surHead and Neck Endocrine Malignancy
gery (n = 347; OR = 0.802, P = .560). Unplanned readmission
James Clark Campbell (Presenter); Hui-Jie Lee;
rates did not differ between open, endoscopic, and robotic
Daniel Rocke, MD
approaches (1.4% vs 1.5% vs 0.9%, P = .684). Mean surgical
Objectives: Higher surgeon volume (SV) correlates with
inpatient stay (in days) after open surgery (mean = 1.23) did
decreased complications (COs) for many operations. No study
not significantly differ from endoscopic (mean = 1.25; P =
has assessed for an association (ASSN) between CO rates and
.877) or robotic surgery (mean = 0.89; P = .166). Mean
SV in patients undergoing lateral neck dissection (LND) for
regional lymph nodes examined in open surgery (mean =
thyroid or parathyroid disease.
3.79) were similar to endoscopic (mean = 3.73; P = .86) and
Methods: The National Inpatient Sample (NIS) and State
robotic (mean = 4.61; P = .183). Rates of positive margins did
Inpatient Database (SID) were queried for discharges with
not significantly differ between open (8.4%), endoscopic
International Classification of Diseases, Ninth Revision codes for
(6.7%), and robotic (9.1%) approaches (P = .083).
LND with a principal diagnosis of thyroid or parathyroid maligConclusions: When accounting for patient demographics and
nancy. For the NIS, we included states with proper surgeon trackclinicopathological features, endoscopic and robotic-assisted
ing from 2000 to 2009. For the SID, we included discharges
approaches to thyroidectomy have a similar length of stay as
during 2013 to 2014 from Florida, Iowa, and New York. The pritraditional open approaches, without compromising margins
mary outcome was any CO common to LND, thyroid, and paraand lymph node yield.
thyroid surgery. The principle independent variable was SV
(LND/year). A univariate logistic regression model with restricted
Managing Thyroid Nodules: Should Size
cubic splines determined the functional form of SV with CO. A
Alone Matter?
multivariable logistic generalized estimating equation adjusted for
Joyce Tang (Presenter); Jasmine Chua; Tian Kai Woon;
confounders and SV was represented by piecewise linear splines.
Bien Soo Tan; Kimberley Kiong
Results: The NIS had 1094 discharges and the SID had
Objectives: The management of thyroid nodules ≥4 cm is
1235. Univariate analysis showed an ASSN between SV quarcontroversial because of conflicting evidence on the diagnostiles and CO rates in the NIS (P = .007) and a 28% overall CO
tic accuracy of fine-needle aspiration cytology (FNAC). Some
rate, with the highest rate in the fourth SV quartile (23-92/
literature quotes high-false negative (FN) rates of more than
year, 37%) and the lowest rate in the first SV quartile (1-2/
13%, whereas recent studies suggest a lower FN rate. We aim to
year, 24%). The SID had no SV-CO ASSN on univariate analinvestigate the differences between thyroid nodules <4 cm and
ysis and a 21% overall CO rate. Regression demonstrated an
≥4 cm, focusing on the diagnostic accuracy of FNAC and the
SV-CO ASSN (P = .007) that resulted in 2 knots at SV 3 and
distribution of cytology and histology results in both groups.
34 in the NIS and no ASSN in the SID (P = .254). For the NIS,
Methods: All thyroid nodules that were subject to ultra1-unit increase in SV was associated with a 3% increase in the
sound (US)-guided FNAC by the interventional radiology
odds of CO when SV was between 4 and 33 (adjusted odds
department of a tertiary institute between December 2011 and
ratio = 1.03, 95% CI, 1.01-1.05).
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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