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Titolo:
Total thyroidectomy or thyroid lobectomy in patients with low-risk differentiated thyroid cancer: Surgical decision analysis of a controversy using amathematical model
Autore:
Kebebew, E; Duh, QY; Clark, OH;
Indirizzi:
Univ Calif San Francisco, Mt Zion Med Ctr, Sch Med, Dept Surg, San Francisco, CA 94120 USA Univ Calif San Francisco San Francisco CA USA 94120 ancisco, CA 94120 USA Vet Affairs Med Ctr, Surg Serv, San Francisco, CA 94121 USA Vet Affairs Med Ctr San Francisco CA USA 94121 an Francisco, CA 94121 USA
Titolo Testata:
WORLD JOURNAL OF SURGERY
fascicolo: 11, volume: 24, anno: 2000,
pagine: 1295 - 1302
SICI:
0364-2313(200011)24:11<1295:TTOTLI>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
PROGNOSTIC SCORING SYSTEM; RETROSPECTIVE ANALYSIS; OPERATIVE STRATEGY; FOLLOW-UP; CARCINOMA; PAPILLARY; SURGERY; COMPLICATIONS; MANAGEMENT; RESECTION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
54
Recensione:
Indirizzi per estratti:
Indirizzo: Kebebew, E Univ Calif San Francisco, Dept Surg, 513 Parnassus Ave,S-343, San Francisco, CA 94143 USA Univ Calif San Francisco 513 Parnassus Ave,S-343San Francisco CA USA 94143
Citazione:
E. Kebebew et al., "Total thyroidectomy or thyroid lobectomy in patients with low-risk differentiated thyroid cancer: Surgical decision analysis of a controversy using amathematical model", WORLD J SUR, 24(11), 2000, pp. 1295-1302

Abstract

There is a general consensus that total or near-total thyroidectomy is theoptimal treatment for patients with high risk differentiated thyroid cancer (DTC), but the optimal extent of thyroidectomy in patients with low risk DTC continues to be controversial. To determine the optimal extent of thyroidectomy in patients with low risk DTC, we used decision analysis to compare the trade-offs of total thyroidectomy (TT) to thyroid lobectomy (TL). Thedecision analysis model included the probabilities of thyroidectomy complications, risk of DTC recurrence, and death from DTC. This information was obtained from the literature and from outcome data for patients with low risk DTC from our institution. In addition, the concept of utilities was used in the analysis. To determine the utility of each health outcome state (thyroidectomy complication, DTC recurrence, and DTC mortality for low risk patients) a survey was conducted. Overall, prospective patients viewed DTC recurrence as less desirable than thyroidectomy complication. The utilities assigned by the survey participants varied over a wide range, with 61.5% of the individuals viewing the occurrence of a thyroidectomy complication as better than DTC recurrence. At baseline utilities and probabilities, TT had ahigher expected utility than TL. One-way sensitivity analysis varying the rates of (1) thyroidectomy complication, (2) DTC recurrence, and (3) DTC mortality over the possible range showed that complication from initial thyroidectomy was the most important factor that determined the preferred extentof thyroidectomy. TL was the preferred surgical approach only if a complication rate of > 33:1, TT/TL complication rate ratio, was assumed. When no differences in DTC recurrence between the two approaches was assumed in the model, TL had a higher expected utility using the baseline utilities of thyroidectomy complication and DTC mortality. The analysis indicates that TT in patients with low risk DTC is preferable to TL. However, TL is preferred if (1) no difference in the DTC recurrence rate between the two approaches is assumed, (2) a higher complication rate for TT is used (> 33 times higher), or (3) the utility ratio of thyroidectomy complication to DTC recurrence is < 0.8 TL. We believe this decision analysis model provides an objective approach that others can use to select the optimal extent of thyroidectomy based on patient preference of health outcome states, institution-specific outcome data for DTC recurrence or mortality, and the surgeon-specific complication rate.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 09/07/20 alle ore 23:17:57