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Abstract

Background

The Calman–Hine Report mandates the need for specialist care of patients with cancer within the UK. The next round of accreditation will include an assessment of care available to patients with thyroid cancer. The Joint Thyroid Cancer Clinic in Sheffield allows secondary and tertiary referral to a multidisciplinary specialist team for the two million people of North Trent.

Methods

A retrospective case record review of the last 159 patients referred to the clinic by specialist and non-specialist surgeons was performed to assess surgical and pathological aspects of care, including preoperative, peroperative and postoperative management, as well as operative morbidity.

Results

A total of 37 surgeons at ten hospitals were involved in the initial management of 128 women and 31 men (mean age 53 (range 10–99) years) with thyroid cancer (111 differentiated, nine medullary, 16 anaplastic, 15 lymphoma, eight others), including 23 general surgeons (69 patients), ten ear, nose and throat surgeons (ten patients) and three specialist endocrine surgeons (66 patients). Non-specialist surgeons carried out 78 reoperative procedures. Histopathological review after referral by a specialist pathologist resulted in a change in diagnosis in 10 per cent of 125 patients (13 cases). Operation-specific surgical morbidity was recorded as follows:

 No. treatedVocal cord palsyHypoparathyroidism
  1. Values in parentheses are percentages

Non-specialist surgeons859(11)16(19)
Endocrine surgeons663(5)5(8)

Cancer Registry data indicated that a further 101 patients with thyroid cancer were never referred to the Joint Thyroid Cancer Clinic during the same period.

Conclusion

In North Trent, despite the presence of a longstanding and well established clinic, many patients with thyroid cancer do not receive specialist/multidisciplinary care. Patients are often treated by surgeons with little experience of thyroid cancer, and the rates of inaccurate pathological diagnosis and operative morbidity are unacceptably high in patients treated by non-specialist teams. © 2000 British Journal of Surgery Society Ltd