The T Stage of Papillary Thyroid Cancer and Its Effect on Regional Complications of Thyroidectomy.

OBJECTIVES

To evaluate the impact of increasing AJCC T stage on postoperative morbidity in patients undergoing thyroidectomy for papillary thyroid cancer.

STUDY

DESIGN

Retrospective cross-sectional database study.

SETTING

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects surgical outcomes data from ~700 US hospitals.

METHODS

NSQIP Participant User Files were queried for thyroidectomy procedures (CPT codes 60210, 60212, 60220, 60225, 60240, 60252, 60254, 60260) from 2016 to 2020 with a pathology-confirmed diagnosis of papillary thyroid cancer. Primary exposure was T stage and outcomes included hoarseness, hypocalcemia, and hematoma formation. Multivariate analysis controlled for N stage, total thyroidectomy, multifocality, and neck dissection.

RESULTS

A total of 10,901 cases were identified (74.2% female; mean age 50.1 ± 15.1 years). Compared to early-stage tumors, T3 cancers were associated with increased risk of hoarseness (OR 1.614, 95% CI 1.260-2.074, P < .01) and 30-day hypocalcemia (OR 1.296, 95% CI 1.022-1.645, P = .03). Upstaging to T4 further increased risks of hoarseness (OR 2.971, 95% CI 2.039-4.282, P < .01), hematoma (OR 2.266, 95% CI 1.027-4.999, P = .04), and hypocalcemia (OR 1.542, 95% CI 1.007-2.364, P < .05). No significant morbidity difference was observed between T1 and T2 tumors.

CONCLUSION

Increasing T stage is associated with significantly higher postoperative morbidity in patients with papillary thyroid cancer, particularly when advancing to T3 or T4. These findings highlight the importance of preoperative risk assessment and surgical planning in advanced disease.