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Updated: Aug 4, 2025
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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
846
Urban and Rural Surgical Practice Patterns for Papillary Thyroid Carcinoma
Reagan A Collins1,2,3, Natalia Chaves1, Gillian Lee4
1Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Summary
The 2015 American Thyroid Association guidelines encouraged less aggressive papillary thyroid cancer (PTC) treatment, leading to more thyroid lobectomies (TL). Practice variations between rural and urban settings diminished post-guidelines, showing improved consistency in care.
Area of Science:
- Endocrinology and Surgical Oncology
- Public Health and Health Services Research
Background:
- The 2015 American Thyroid Association (ATA) guidelines recommended less aggressive management for papillary thyroid cancer (PTC).
- This shift influenced surgical practices, favoring thyroid lobectomy (TL) over total thyroidectomy (TT), yet regional practice variations persisted.
- Understanding factors influencing these variations, particularly between rural and urban settings, is crucial for equitable patient care.
Purpose of the Study:
- To evaluate surgical management trends for PTC in rural versus urban populations after the 2015 ATA guidelines.
- To assess changes in the rates of thyroid lobectomy (TL) compared to total thyroidectomy (TT) based on geographic setting.
- To identify if the 2015 guidelines reduced practice variations in PTC surgical management between rural and urban areas.
Main Methods:
- Retrospective cohort analysis of localized PTC cases (<4 cm) from the SEER database (2004-2019).
- Patients were categorized as urban or rural based on 2013 Rural-Urban Continuum Codes.
- Surgical procedures were classified as pre-guideline (2004-2015) and post-guideline (2016-2019); statistical analyses included chi-square, t-test, logistic regression, and CMH tests.
Main Results:
- A total of 89,294 PTC cases were analyzed; 89.8% urban, 9.2% rural.
- Rural patients were older and had smaller nodules. Adjusted analysis showed rural patients were less likely to undergo TT (aOR 0.81).
- Pre-2015, urban patients had higher odds of TT (OR 1.24). Post-2015, no significant difference in TT vs. TL proportions existed between urban and rural settings (p=0.185).
Conclusions:
- The 2015 ATA guidelines successfully promoted a shift towards less aggressive surgical management, increasing thyroid lobectomy (TL) rates overall.
- Pre-guideline practice variations in TT vs. TL between urban and rural settings were observed.
- Post-guideline implementation, both rural and urban settings demonstrated increased TL, indicating improved practice consistency and adherence to guidelines.
