Kai Guo1, Xiaoke Zheng1, Duanshu Li1, Yi Wu1, Qinghai Ji1, Zhuoying Wang2. 1. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai 200032, China. 2. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai 200032, China. Electronic address: zhuoyingwang@hotmail.com.
Abstract
BACKGROUND: There are two surgical strategies for bilateral neck dissection (BND), simultaneous and two-stage operations. The aim of the study was to compare the cost-effectiveness BND with this two operations in papillary thyroid carcinoma (PTC) patients. MATERIALS AND METHODS: Consecutive PTC patients undergoing BND were studied retrospectively, and were classified into simultaneous group (Group A) and two-stage group (Group B). Demographic, medical costs, complication and surgical variables were recorded. RESULTS: This study included 256 PTC patients, of which 175 (68.4%) underwent simultaneous BND and 81 (31.6%) patients underwent two-stage. Patients in Group B spent almost twice as much on medical costs as patients in Group A ($4145.3 vs. $7352.5). Group A patients also had shorter hospital stays (11.71 ± 5.12 vs. 23.10 ± 7.11, P < .0001) and surgery times (203.61 ± 61.43min vs. 279.58 ± 71.59min, P < .0001). The average radioactive iodine therapy delay was 67 days in Group B. There was no significant difference in complications (34 vs. 18, P = .605) or disease-free-survival (93.71% vs. 90.12%, P = .243) between the two groups. No difference was found in rates of recurrent laryngeal nerve invasion/resection (12 vs. 11, P = .08; 10 vs. 6, P = .353) or tracheotomy (32 vs. 14, P = .846). However, internal jugular vein invasions were more common in patients with two-stage BND (7 vs. 9, P = .029). CONCLUSION: Simultaneous BND is the most cost-effective strategy for the management of PTC patients without bilateral internal jugular veins invasion, due to lower treatment cost and the ability to avoid RAI delay.
BACKGROUND: There are two surgical strategies for bilateral neck dissection (BND), simultaneous and two-stage operations. The aim of the study was to compare the cost-effectiveness BND with this two operations in papillary thyroid carcinoma (PTC) patients. MATERIALS AND METHODS: Consecutive PTC patients undergoing BND were studied retrospectively, and were classified into simultaneous group (Group A) and two-stage group (Group B). Demographic, medical costs, complication and surgical variables were recorded. RESULTS: This study included 256 PTC patients, of which 175 (68.4%) underwent simultaneous BND and 81 (31.6%) patients underwent two-stage. Patients in Group B spent almost twice as much on medical costs as patients in Group A ($4145.3 vs. $7352.5). Group A patients also had shorter hospital stays (11.71 ± 5.12 vs. 23.10 ± 7.11, P < .0001) and surgery times (203.61 ± 61.43min vs. 279.58 ± 71.59min, P < .0001). The average radioactive iodine therapy delay was 67 days in Group B. There was no significant difference in complications (34 vs. 18, P = .605) or disease-free-survival (93.71% vs. 90.12%, P = .243) between the two groups. No difference was found in rates of recurrent laryngeal nerve invasion/resection (12 vs. 11, P = .08; 10 vs. 6, P = .353) or tracheotomy (32 vs. 14, P = .846). However, internal jugular vein invasions were more common in patients with two-stage BND (7 vs. 9, P = .029). CONCLUSION: Simultaneous BND is the most cost-effective strategy for the management of PTC patients without bilateral internal jugular veins invasion, due to lower treatment cost and the ability to avoid RAI delay.