Surgical Complications and Referral Patterns in 567 Patients with Differentiated Thyroid Cancer in the Northern Region of the Netherlands: A Population-Based Study Towards Clinical Management Implementation

Abstract

Background. In the Netherlands, differentiated thyroid cancer (DTC) is treated surgically in three different hospital types, including university, teaching, and nonteaching peripheral hospitals. This study evaluates postoperative complications and referral patterns in patients with DTC in the northern region of the Netherlands to gain an understanding on how to improve management implementation. Methods. Data from 567 patients diagnosed between 1989 and 2009 were obtained from the Netherlands Cancer Registry and were supplemented with information from hospital digital information systems and patient records from 15 hospitals: 1 university, 3 teaching, and 11 peripheral hospitals. Surgically treated patients with a histologically proven DTC derived from the original pathology reports were included. Results. Surgical treatment could be performed in a single procedure in 234 patients (41.3%), but several surgeries were needed in the remaining 333 patients (58.7%). Recurrent laryngeal nerve (RLN) palsy occurred after all types of thyroid surgical procedures, but mostly after initial (hemi)thyroidectomy and reoperations. RLN was temporary in 3.2% of the nerves at risk and persistent in 1.8%. Temporary hypocalcemia developed in 13.7% of patients, and persistent hypocalcemia occurred in 4.8%. Patients were mainly referred to the university hospital from a nonteaching (40.7%, 48/118) or teaching hospital (11.1%, 16/144); however, 80% of patients were not referred. Conclusions. The complication rate and number of multiple surgeries support the efforts in optimizing clinical management in thyroid cancer. Careful considerations prior to initial surgical treatment by early discussion in telemedicine-based regional tumor boards could possibly prevent reoperations and potentially diminish complications.

The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines

“…Furthermore, inclusion from only a single tertiary center may be considered a strength, although we could not exclude a selection of patients with more aggressive disease. 36 This study shows, according to our estimation, that low-risk patients were treated too aggressively when using current Dutch guidelines (NL-15), while the less aggressive approach of ATA-15 seems more adequate. This pleads for further de-escalation of treatment strategy in Netherlands.…”

“…Furthermore, inclusion from only a single tertiary center may be considered a strength, although we could not exclude a selection of patients with more aggressive disease. 36 …”

Tackling Thyroid Cancer in Europe—The Challenges and Opportunities

“…The Netherlands has an effective register based on pathology, and centralisation of care is seen as the best way forward to improve care for rare diseases [ 54 ]. Reimbursement by the hospitals can lead to limited clinical use of advanced testing tools; somatic genetic testing is available, but mainly as a part of panels used for other malignant tumors.…”