2021 Endocrine Surgery Annual Report

Annual Report 2021

Endocrine Surgery

SERT Institute

Contents

Endocrine Surgery Royal North Shore Hospital

Foreword

Snapshot

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Executive Summary

2021 Highlights

National endocrine society and registry update

Q&A with Dr Alex Papachristos

Presentations and meetings

Royal North Shore Hospital. Published November 2022

Staff Updates

2021 Data Summary

Demographics

Elective operative cases performed

Thyroid cases

Parathyroid cases

Adrenal cases

Morbidity and mortality

Time trends

General / emergency operative cases

Acknowledgements

Glossary

Foreword

Endocrine Surgery 2021 Snapshot

1337 322 90%

From the Head of Endocrine Surgery, RNSH

I am pleased to present the 2021 Annual Report for the Royal North Shore Hospital (RNSH) Endocrine Surgery Department. The last 12 months proved to be a year of two halves for our department. The year began with business as usual, however as we moved in to the second half of 2021, the spread of the Delta strain of COVID-19 saw the closure of elective surgery lists in the public hospital for five months, and private hospital for four months, which had a significant impact on our work. When elective surgery did resume at the end of 2021, we were greeted by the surge in the Omicron variant of COVID-19. Similar to the previous year, 2021 was definitely a year of disruption. Despite the restrictions on elective surgery across both public and private hospitals, the team was able to conduct more than 1,330 cases; a 4% increase on the previous year. Throughout 2021, the department continued to provide excellent patient care and worked hard to reduce surgery wait times and meet community expectations. I would like to thank the team for adapting to the situation and keeping our clinical and translational research activities moving forward during what was a difficult year. After a tumultuous couple of years, I am confident the department is well positioned to work through any challenges that may arise in 2022.

Elective endocrine procedures There were 1337 elective operative cases performed over the 12-month period from January–December 2021. The reporting period includes the continuing COVID-19 global pandemic.

Cancer cases A total of 322 cancer cases were surgically treated over this reporting period. The most common pathology was papillary carcinoma.

Thyroid/parathyroid procedures A total of 90% of the endocrine workload was for thyroid/parathyroid procedures. Of the 1337 elective operative cases, 830 operations were for thyroid-only cases, 288 were for parathyroid- only cases, and 91 were for both thyroid and parathyroid cases.

Professor Stan Sidhu Head of Endocrine Surgery, RNSH

Research publications 14 research publications were produced over this reporting period.

Endocrine Surgery Annual Report 2021

Executive Summary

2021 Highlights

This report gives an overview of the activity and achievements of the Royal North Shore Hospital Endocrine Surgery Department throughout 2021. The work of the department was again disrupted by the COVID-19 pandemic in 2021, with the Delta strain outbreak resulting in elective surgery being abruptly ceased across Australia on 2 August. Despite the restrictions placed on surgery at this time, there were a total of 1,337 endocrine operative cases involving 1,290 patients performed across the RNSH campus in 2021. The patients were largely from local health districts (LHDs) across NSW (98%), with a small number coming from interstate (2%); the largest cohort resided in Northern Sydney LHD (44%). The most common cases treated in 2021 involved thyroid-only (62%) and parathyroid-only surgery (22%). The distribution of public and private procedures was similar to the previous year, with 72% of total cases conducted at private hospitals and 28% at public hospitals. While cases increased by 4% in 2021, there was an 11% decline in total surgical cases compared to the 2020 figure due to pandemic-related restrictions on elective surgery. It is important to note that complications from the department’s surgical caseload have continued to decrease steadily since 2000. The team produced a total of 14 publications in 2021 and the department also continued to contribute to the Australian & New Zealand Thyroid Cancer Registry (ANZTCR) which is a binational clinical quality registry that collects information relating to the diagnosis, treatment, and outcomes of individuals diagnosed with thyroid cancer. In late 2021 and early 2022, the department expanded its Research Electronic Data Capture (REDCap) database to incorporate fields that provide information on parotid and submandibular operations. The sections on thyroid and parathyroid operations were also further refined to better reflect data collection.

The RNSH Endocrine Surgery Department welcomed seven Doctor of Medicine (MD) students in 2021, all of whom contributed fantastic work under the supervision of the consultants. The department also welcomed two registrars and two fellows, who all had solid terms, and a clinical research fellow who was another beneficial addition to the team. In 2021, department members were able to return to attending conferences and large meetings in both physical and virtual capacities. Members of the department lectured at seven conferences and international meetings, which is a fantastic effort, given the continued disruptions faced in 2021 due to ongoing COVID-19 outbreaks.

Endocrine Surgery Annual Report 2021

Australian & New Zealand Thyroid Cancer Registry

This involved Bianka D’Souza, a Master of Public Health (Research) student completing a qualitative research study, which lead to the award of her Master’s thesis with co-supervision from A/Prof Anthony Glover. The ANZTCR has now recruited more than 2,000 patients, and from 2022 the registry will present the first set of quality performance indicators, for which RNSH will be a major contributor. The performance indicators will provide insight into thyroid cancer care across greater Australia.

Throughout 2021, the RNSH Endocrine Surgery Department continued to provide support and data for the Australia and New Zealand Thyroid Cancer Registry (ANZTCR). The ANZTCR is based at Monash University and aims to provide benchmarks for thyroid cancer care. The RNSH department continued to be the highest contributing department to the registry, which now includes over 40 hospitals. Endocrine Data Manager, Dr Ahmad Aniss, streamlined the delivery of data from the RNSH Endocrine Surgery Database, allowing the ANZTCR to grow and develop within the existing workflows of the department. This led to further research projects and collaboration between Australian New Zealand Endocrine Surgeons (ANZES) and ANZTCR. One project of note involved an investigation of patient experiences of treatment delays due to the COVID-19 pandemic.

ANZES Members

National Endocrine Society & Registry In 2021, the Endocrine Surgery Australian New Zealand Endocrine Surgeons

cancer care. In an international project undertaken in collaboration with the Sydney School of Public Health, clinicians reported that while patients with thyroid cancer experienced delays to treatment, these were generally for lower risk patients and affected presentations overall, rather than clinically urgent presentations. This project led to a publication with the ANZ Journal of Surgery, and a project to further understand the experiences of patients who had treatment delays due to the pandemic was launched with the ANZ Thyroid Cancer Registry.

Other achievements from ANZES in 2021 included: • Publication of the inaugural ANZ parathyroid treatment guidelines, for which

Under the leadership of Clin. A/Prof Mark Sywak and Professor Julie Miller (President), the society continued to grow in membership throughout 2021.

Department at RNSH continued to make a major contribution to the Australian New Zealand Endocrine Surgeons (ANZES) Society. A/ Prof Mark Sywak served as the Public Officer and A/ Prof Anthony Glover served as the Scientific and Research Officer with the ANZES Executive. One of the ANZES 2021 initiatives was to understand the impact of the COVID-19 pandemic on thyroid

Clin. A/Prof Mark Sywak, A/Prof Anthony Glover, and Professor Stan Sidhu provided expert advice. Continuation of the ANZES Endocrine Surgery Fellowship training scheme, which is currently being led by Associate Professor Justin Gundara, a former PhD student and trainee with the department and the Kolling Institute.

•

Endocrine Surgery Annual Report 2021

the ground’ – to gain an authentic understanding of the issues that are being addressed. In addition, it was a greatly beneficial experience in clarifying the governance structures within the LHD, particularly the pathways involved in escalating issues relating to clinical practice, as well as opportunities for formal engagement with leadership roles. 4 Overall, how would you describe your experience with the FLASH program? As participants in the pilot program, we all felt FLASH was a resounding success and look forward to maintaining the connections we made with our early-career colleagues. I would like to acknowledge the tireless effort of Associate Professor Sandra Turner, Ms Jane Bolster, Dr Henry Maung, Dr Francesca Rannard, Ms Sonja Cronjé, A/Prof Anthony Glover and Ms Cecilia Keung, who formed the backbone of the FLASH committee – without them, the program would not have been possible. For anyone considering participating in the FLASH program in future, you will not be disappointed.

experience as a clinician and entrepreneur Professor Carmelle Peisah on approaching resistance to change Associate Professor Kristopher Rallah-Baker, Associate Professor Rhea Liang and Dr Renee Lim who shared

The FLASH program provided me with the opportunity to shadow a senior leader within our LHD. I was lucky enough to spend a day with both Deborah Willcox (Chief Executive, NSLHD) and Dr Adam Rehak (Clinical Director, Division of Surgery and Anaesthesia, RNSH). As a clinician, most of what I had previously learned about leadership had come from observation of mentors, and usually centred on the immediate clinical care team. However, in a broader context, the concept of leadership felt somewhat vague and removed from daily clinical practice. The shadowing experience provided a valuable insight into this world and consolidated the FLASH course content. It highlighted the complexity of the competing pressures that must be equitably balanced on an administrative level when running a healthcare system, as well as the importance of personally engaging with team members – particularly those ‘on 3 What was the highlight of the program? difficult interactions and to form a framework to approach conflict productively.

Q&A RNSH Endocrine Surgeon Excels in FLASH Program

•

inspiring insights into their personal journeys on driving culture change in the workplace. The overarching theme of self- care was interwoven through the seven sessions. Ms Sonja Cronje, a professional coach, guided us through mindfulness activities and offered individual coaching sessions to participants. The importance of self-awareness and reflection were reinforced, and were particularly relevant to understanding our individual responses to conflict and stress. In preparation for the FLASH program, we completed the Insights Discovery psychometric profile to help us better understand our communication and interpersonal interaction methods, as well as to identify styles of communication we find more difficult to engage with. This was revisited in several contexts throughout the program, and it provided us with the tools to optimise

Dr Alex Papachristos

The FLASH program was designed by a diverse interprofessional team and aims to bridge the gap between clinicians and leaders within the healthcare system, specifically targeting early career consultants, and was developed around the Australian Health Leadership LEADS framework. 1 What is the FLASH program? The program was conducted over a seven-month period, with monthly full day sessions – this was initially delivered online due to COVID-19 restrictions, but culminated in two fantastic face-to-face sessions. Through the comprehensive and well- structured program, we explored the theoretical foundations and practical considerations relevant to leadership, culture change, 2 What does the program involve?

and driving innovation within the healthcare context. We were privileged to have Professor Kevin Lowe from the University of Sydney Business School to help us apply structure to the way we conceptualise accessible, described the lessons we can learn from high-performing teams, and provided us with the language necessary to engage with the leadership community of practice. Other particularly engaging talks were delivered by: • leadership. He made the theoretical content highly

Dr Alex Papachristos is a general and endocrine surgeon at RNSH, who is currently undertaking a PhD exploring novel therapy in advanced thyroid cancer. In 2021, Dr Papachristos took part in the pilot Fostering Leadership Across Systems in Health (FLASH) program.

Professor Bruce Robinson on demystifying the governance structures within the Australian healthcare system Professor Peter Hockey and Mr Graeme Loy on the executive perspectives in the healthcare leadership context Professor Tony Young on his

•

FLASH Program participants

Endocrine Surgery Annual Report 2021

Staff Updates

Presentations and Meetings

Professor Stan Sidhu 1. Endocrine Section Visiting Professor for the Royal Australasian College of Surgeons meeting in Melbourne.

This was a hybrid meeting, with face-to-face attendance mainly by Melbourne surgeons and interstate surgeons attending virtually.

As the only Section Visitor attending in person, Professor Sidhu was responsible for: • Assessing the registrar’s oral abstracts

• Being a panel member on ‘how I do it’ sessions • Challenging early and mid-career presenters

2. Keynote lecturer at the Royal Australasian College of Surgeons Annual Scientific Congress in May 2021: “Total Thyroidectomy - What’s Old is New Again”. 3. International Association of Endocrine Surgeons (IAES) State of the Art lecture: “RNA-based therapeutics in disease and cancer: Is there a role in Endocrine malignancy?” The IAES State of the Art lecture is the highest honour for a member, giving them the opportunity to present their original work to the Association. This lecture encompassed more a decade’s worth of translational research in this field. Clinical Associate Professor Mark Sywak 1. Invited lecturer at the General Surgeons Australia National Surgical Education and Training Course: Management of Thyroid Nodular Disease. 2. Invited lecturer at the Royal Australian College of General Practitioners and Manly Warringah Division of General Practice: “Investigation of hypercalcemia and surgical techniques in parathyroidectomy”. A/Prof Sywak was admitted to the Court of Examiners of the Royal Australasian College of Surgeons (RACS) and participated in College examinations in May, June and November 2021. He was also elected to the Executive of the Endocrine Surgery Section of the RACS in December 2021. A/Prof Sywak continues his roles as Public Officer for the Australian and New Zealand Endocrine Surgeons Association and as a member of the Scientific Committee for the International Association of Endocrine Surgeons postgraduate course. Associate Professor Anthony Glover 1. Invited lecturer at the Royal Australasian College of Surgeons Annual Scientific Congress (RACS ASC) Endocrine Section: “Recognising and managing unusual parathyroid conditions”. 2. Invited lecturer at the RACS ASC Surgical Oncology Section: “Applying novel circulating biomarkers to the clinic for patients with cancer”.

Endocrine Surgery Annual Report 2021

STAFF UPDATE

Dr David Leong joined the RNSH Endocrine Surgery Department following a previous Fellowship position in Melbourne. On completion of his training at RNSH, Dr Leong will return to Perth as a Consultant Surgeon. T.S. Reeve International Endocrine Surgery Fellow

Dr Robert Mechera has undertaken a second Fellowship year with the RNSH Endocrine Surgery department. Dr Mechera is due to complete his Australian Surgical Odyssey with Dr Peter Campbell at St George Hospital in 2023. When he returns to Switzerland, Dr Mechera aims to establish a dedicated Endocrine Surgery department in the Basel University Hospital. Australian and New Zealand Endocrine Surgeons (ANZES) Fellow

Doctor of Medicine (MD) Students

Dr Chehade has a medicine background and was keen to undertake a PhD focusing on the role of noncoding RNA PRINS in endocrine cancer. After completing her PhD, Dr Chehade has returned to the Surgical Education and Training (SET) program. Doctoral Students Supervisor: Prof Stan Sidhu Dr Marthe Chehade

Lucy Birtwistle

Lucy is a stage 3 student at Sydney Medical School and is undertaking a study into the evolution of minimally invasive surgical techniques in the management of adrenal disease. She is due to complete her degree in 2023. Supervisor: Clin. A/Prof Mark Sywak

Kevin Wang

Supervisor: Prof Stan Sidhu

Kevin completed his lab-based MD project in 2021. He focused on learning skills such as RNA extractions, qPCR, cloning, cell culture and phenotypic assays and was able to demonstrate the functional role of PRINS in breast cancer cell lines.

Tony Lian

Tony is a third year student undertaking his MD project within the department in 2021 and 2022. Tony’s project is focused on neuromonitoring in thyroid surgery titled: “A prospective study of electromyographic amplitude changes during intraoperative neural monitoring for open thyroidectomy”. Supervisor: Clin. A/Prof Mark Sywak

Dr Anila Hashmi

Krishna Vikneson

Dr Hashmi has continued PhD research which she started in 2020 examining the role of miRNA isoforms in adrenal cancer pathogenesis and utility as a diagnostic and prognostic marker. Dr Hashmi has made significant strides in highlighting the uniqueness of the miRNA machinery in adrenocortical carcinoma compared to other malignancies.

Krishna completed a MD honours research year and was awarded a high distinction for his work on the association of tumour volume and pathological outcomes in T1 differentiated thyroid cancers. Supervisor: A/Prof Anthony Glover

Tariq Haniff

Tariq completed a MD honours research year and was awarded a distinction for his work on predictive factors for recurrent laryngeal nerve injury in parathyroid surgery. Supervisor: A/Prof Anthony Glover

Dr Alex Papachristos

Dr David Leong

Dr Papachristos has transitioned from the T.S. Reeve Fellowship position to begin his doctoral studies on developing novel therapies for the management of advanced thyroid cancer. He is working with a leading biotech firm, EngeneIC, to use their nanoparticle platform for the treatment of locally advanced and metastatic poorly differentiated thyroid cancer and medullary thyroid cancer in mouse models, with the view to advance this work to human trials.

Dr Andrew Ooi participated in research activities within the department as a Clinical Research Fellow, Master’s Student candidate and Senior Surgical Resident. He undertook a study into clinical outcomes following surgery for thyroid cancer: “A two-decade experience in the management of differentiated thyroid carcinoma.” The study involved a collaboration with the University of Otago and investigated the role of machine learning in large clinical datasets. Clinical Research Fellow

Jessica Wei

Dr Robert Mechera

Jessica completed a research project for her MD/Arts degree with a systematic review on factors used for patient decision making in low risk thyroid cancer. Supervisor: A/Prof Anthony Glover

Registrars

Dr Jonathan Hew and Dr Jakob Koestenbauer were the two advanced trainees at RNSH in 2021. Both the trainees have completed their fellowship exam and had solid terms within the Endocrine Surgery department.

Henry Crayton

Henry started an extended MD honours project looking at the genotype-phenotype relationship of diffuse sclerosing variant papillary thyroid cancer which he will complete in early 2022. Supervisor: A/Prof Anthony Glover

University of Sydney

Endocrine Surgery Annual Report 2021

2021 Data Summary

Demographics

The following information is a summary of the data output from the RNSH Endocrine Surgery databases for 2021.

In 2021, there was a total of 1337 elective endocrine operative cases performed which were attributed to 1290 patients. This is due to some patients having more than one operation during the year.

Elective operative cases performed

Patients

Gender The majority of operative cases were performed on 950 female patients (73.6%) compared to 340 male patients (26.4%) (Figure 1).

Figure 1: Gender distribution of all patients

Endocrine Surgery Annual Report 2021

Age

Residence

The mean age for all patients was 56.5 (SD: ± 15.9). For females, the mean age was 55.6 (SD: ± 15.8). For males, the mean age was 59 (SD ± 16).

Figure 3A shows the distribution of patients seen by consultants from RNSH across the Local Health Districts (LHDs) in NSW. The majority of patients (44.4%) resided in the Northern Sydney Local Health District, followed by 14.0% from the Mid North Coast Local Health District (Table 1).

Figure 2 shows the overall age distribution (2A) and by gender (2B).

Figure 3A. Geographical distribution of endocrine elective patients across the NSW LHDs.

NSW LHD breakdown and interstate

Local Health District

Northern Sydney

542

44.4

Australian Capital Territory 17

1.4

Mid North Coast

171

14.0

Western NSW

1.3

Central Coast

7.5

Nepean Blue Mountains 14

1.1

Western Sydney

7.1

Southern NSW

0.9

Sydney

5.2

Murrumbidgee

0.6

South Eastern Sydney

4.5

Queensland

0.5

Figure 2. Age Distribution. (A) Overall age distribution. (B) Age distribution split by gender

South Western Sydney

3.4

Tasmania

0.2

Hunter New England

3.2

Far West

0.1

Illawarra Shoalhaven

2.2

Northern Territory

0.1

Northern NSW

2.0

Victoria

0.1

Table 1. Breakdown of patients across NSW LHDs and Interstate

Endocrine Surgery Annual Report 2021

Elective operative cases performed

Residence (continued)

Case type Figure 4 shows the breakdown of the 1337 elective operative cases by case type.

In 2021 there were:

• •

830 (62.1%) thyroid-only cases 288 (21.5%) parathyroid-only cases

• • •

10 (0.7%) thyroglossal-only cases 8 (0.6%) submandibular-only cases 7 (0.5%) cases classified as ‘Other’.

• 91 (6.8%) both thyroid and parathyroid cases • 70 (5.2%) adrenal cases • 33 (2.5%) parotid-only cases

Figure 3B. Geographical distribution of patients in the NSLHD Local Government Areas (LGAs)

NSLHD LGA breakdown

NSLHD LGAs

Northern Beaches

174

32.1

Lane Cove

3.7

Hornsby

18.1

Mosman

1.7

Ku-ring-gai

16.2

Hunters Hill

1.3

North Sydney

10.7

Ryde

8.3

Willoughby

7.9

Table 2. Breakdown of patients across the NSLHD LGAs

Figure 4. Breakdown of operative cases by case type

Endocrine Surgery Annual Report 2021

Other case type breakdown

Cases by hospital The majority of elective operative cases were performed at private hospitals (968 cases, 72.4%) compared to 369 cases (27.6%) in the public sector. Figure 5 shows that the largest proportion of cases were performed at North Shore Private (NSP) (26.8%) and Mater (22.9%) hospitals.

Table 3 provides a breakdown of the ‘Other’ cases.

Other Case Type

Branchial cyst

0.1

Branchial excision

0.1

Excision of left supraclavicular mass

0.1

Excision of right supraclavicular lipoma

0.1

Excision of sebaceous cyst

0.1

Paraganglioma

0.1

Parapharyngeal procedure

0.1

Table 3. Other case type breakdown

Figure 5. Number of operative cases by hospital

Endocrine Surgery Annual Report 2021

Thyroid cases

Length of stay and surgery time Table 4 summarises the length of stay and surgery time for each of the operative case types. Note: this data was available for RNSH and Hornsby patients only.

Operative Case Type Median Total LOS (days)

IQR Total LOS (days)

Median Surgery Time (hours)

IQR Surgery Time (hours)

Thyroid-only

1, 2

Primary vs secondary thyroid procedures The majority of elective thyroid procedures in 2021 were primary (87.4%) (Figure 6).

Parathyroid-only

1, 1

Both (Thyroid/parathyroid) 2

1, 2

Note: primary procedure refers to the first instance of a thyroid procedure for an individual patient and secondary refers to any subsequent thyroid procedure.

Adrenal

2, 4

2, 3

Parotid-only

1, 2

2, 3

Thyroglossal-only

1, 1

Submandibular-only

1, 1

Other

3, 5

2, 2

Table 4. Length of stay and surgery time summary

Figure 6. Primary vs secondary thyroid procedures

Endocrine Surgery Annual Report 2021

Thyroid procedure types

Indications for thyroid procedure Table 6 summarises the various indicators for thyroid procedures. Note: each operative case may have multiple indications. The most common indicators for thyroid procedures were compression (34.7%) and risk of malignancy (33.1%).

Figure 7 shows the most common thyroid procedure types were hemithyroidectomy (45.0%) and total thyroidectomy (41.6%).

Indications

Compression

320

34.7

Risk of malignancy

305

33.1

Malignancy

171

18.6

Retrosternal goitre

9.4

Graves' disease

6.5

Other

6.3

MNG toxic

4.5

Single nodule toxic

1.5

Growth

1.3

MNG nontoxic

0.9

Single nodule nontoxic

0.2

Hyperparathyroidism

0.1

Table 6. Indications for thyroid procedure

Figure 7. Thyroid procedure types

Other thyroid procedure types

Table 5 outlines the breakdown of the ‘Other’ thyroid procedure types. The most common ‘Other’ procedure type was lymph node surgery (2.7%).

Other procedure type

Lymph node surgery

2.7

Partial biopsy of right Lobe

0.1

Partial right lobeectomy

0.1

Resection of thyroid rest and remanent

0.1

Subcutaneous nodule

0.1

Table 5. Other thyroid procedure type breakdown

Endocrine Surgery Annual Report 2021

Thyroid cases by geographical area

NSW LHDs and Interstate

Figure 8 shows the geographical area where elective thyroid case patients resided by LGA across NSLHD. Table 7 provides a breakdown of patients by LHD and interstate.

Northern Sydney

400

45.6

Mid North Coast

106

12.1

Western Sydney

7.8

Central Coast

7.0

Sydney

5.5

South Eastern Sydney

4.6

South Western Sydney

3.8

Hunter New England

3.0

Illawarra Shoalhaven

2.4

Northern NSW

2.2

Nepean Blue Mountains

1.5

Australian Capital Territory

1.3

Western NSW

1.0

Murrumbidgee

0.8

Southern NSW

0.7

Queensland

0.6

Tasmania

0.2

Northern Territory

0.1

Victoria

0.1

Table 7. Breakdown of thyroid patients across NSW LHDs and interstate

Figure 8. Geographical distribution of elective thyroid patients in NSLHD LGAs

Endocrine Surgery Annual Report 2021

Thyroid cancer cases by geographical area

Thyroid pathology types Table 8 summarises the various thyroid pathology types. The majority of pathology types were benign MNG (45.3%) and other pathology (16.9%).

Figure 9 shows the geographical area where thyroid case patients resided by LGA across the NSLHD. Table 10 provides a breakdown of patients by LHD and interstate.

Thyroid pathology type

Benign MNG

417

45.3

Other pathology

156

16.9

Sub-acute thyroiditis

6.2

Follicular adenoma

5.9

Diffuse hyperplasia (graves)

5.1

Hashimoto's thyroiditis

4.8

Residual thyroid - non carcinoma

2.4

Hurthle cell adenoma

2.2

Single colloid nodule

2.2

Simple cyst

0.8

Uncertain malignant potential

0.1

Unknown

0.1

Table 8. Thyroid pathology type summary

Thyroid cancer pathology types

Table 9 summarises the various thyroid cancer pathology types. The most common pathology was papillary carcinoma (28.3%).

Thyroid cancer pathology type

Papillary carcinoma

261

28.3

Follicular carcinoma

3.0

Hurthle cell carcinoma

1.3

Medullary carcinoma

1.2

Poorly differentiated carcinoma

0.7

Lymphoma

0.2

Other

0.2

Table 9. Thyroid cancer pathology type summary

Figure 9. Geographical distribution of thyroid cancer patients in the NSLHD LGAs

Endocrine Surgery Annual Report 2021

Parathyroid cases

NSW LHDs and Interstate

Northern Sydney

136

44.4

Western Sydney

12.1

Mid North Coast

9.2

Sydney

7.8

Primary vs secondary parathyroid procedures Figure 10 shows the majority of elective parathyroid procedures were primary (95%) compared to secondary (5%) for 2021. Note: Primary procedure refers to the first instance of a parathyroid procedure for an individual patient and secondary refers to any subsequent parathyroid procedure.

Central Coast

6.2

South Eastern Sydney

5.6

South Western Sydney

3.3

Illawarra Shoalhaven

2.3

Hunter New England

2.0

Northern NSW

1.6

Australian Capital Territory

1.0

Queensland

1.0

Western NSW

1.0

Murrumbidgee

0.7

Nepean Blue Mountains

0.7

Tasmania

0.7

Southern NSW

0.3

Victoria

0.3

Table 10. Breakdown of thyroid cancer patients across NSW LHDs and interstate

Figure 10. Primary vs secondary parathyroid procedures

Endocrine Surgery Annual Report 2021

Parathyroid cases by geographical area

Parathyroid procedure types Figure 11 shows the breakdown of procedure types for parathyroid cases. The most common were excision of single gland (74.1%) and excision two glands (18.2%).

Figure 12 shows the geographical area where thyroid case patients resided by LGA across NSLHD. Table 11 provides a breakdown of patients by LHD and interstate.

Procedure Types

Figure 11. Parathyroid procedure types

Figure 12. Geographical distribution of elective parathyroid patients in the NSLHD LGAs

Endocrine Surgery Annual Report 2021

Surgical approach for parathyroid cases Figure 13 shows the surgical approach for the parathyroid cases. The most common was open parathyroidectomy (52.8%), followed by Minimally Invasive Procedure (MIP) (44.0%), and MIP converted to open (3.2%).

NSW LHDs and interstate

Northern Sydney

151

40.3

Mid North Coast

16.8

Central Coast

8.8

Western Sydney

6.9

Sydney

4.3

South Western Sydney

4.0

Hunter New England

3.7

South Eastern Sydney

3.7

Northern NSW

2.7

Western NSW

2.1

Illawarra Shoalhaven

1.9

Australian Capital Territory

1.3

Southern NSW

1.3

Figure 13. Surgical approach for parathyroid cases

Nepean Blue Mountains

0.8

Parathyroid pathology types Figure 14 shows the various parathyroid pathology types. The most common pathology was single adenoma present (74.4%), followed by two adenomas present (9.2%).

Tasmania

0.5

Far West

0.3

Murrumbidgee

0.3

Queensland

0.3

Table 11. Breakdown of parathyroid patients across NSW LHDs and interstate

Figure 14. Parathyroid pathology types

Endocrine Surgery Annual Report 2021

Adrenal cases

Indications for adrenal procedure Figure 16 shows the indications for adrenal procedure. The most common indications were phaeocromocytoma (31.4%), incidentaloma (28.6%) and hyperaldosteronism (14.3%).

Adrenal procedure types

All elective adrenal procedures in 2021 were adrenalectomies.

Surgical approach for adrenal cases

Figure 15 shows the different surgical approaches for adrenal cases. Most were posterior retroperitoneoscopic (62.9%) cases.

Indications

Figure 16. Indications for adrenal procedures

Adrenal pathology types Figure 17 shows the various adrenal pathology types. The most common pathology was adrenal cortical adenoma (44.3%), followed by phaeochromocytoma (20%).

Surgical Approach

Figure 15. Surgical approach for adrenal cases

Figure 17. Adrenal pathology types

Endocrine Surgery Annual Report 2021

Morbidity and mortality

Parathyroid complications Table 13 provides an overview of complications across all elective parathyroid cases in 2021.

The most common complications were persistent hyperparathyroidism and temporary RLN palsy (1.1%).

Parathyroid complications

Percentage of total thyroid patients (%)

Temporary RLN palsy

4 1.1

Thyroid complications Table 12 provides an overview of complications across all elective thyroid cases in 2021.

Persistent hyperparathyroidism

4 1.1

Seroma

3 0.8

The most common complication was temporary RLN palsy (2.7%).

Temporary hypocalcaemia

2 0.5

Thyroid complication

Percentage of total parathyroid patients (%)

Permanent RLN palsy

0.3

Other

0.3

Temporary RLN palsy

25 2.7

Permanent hypoparathyroidism

0.3

Temporary ELN palsy/damage

4 0.4

Wound infection

0.3

Temporary hypocalcaemia

4 0.4

Temporary ELN palsy/damage

0 0.0

Haemorrhage (return to theatre within 48hrs)

3 0.3

Haemorrhage (return to theatre within 48hrs)

0 0.0

Persistent hyperparathyroidism

2 0.2

Tracheostomy

0 0.0

Permanent RLN palsy

2 0.2

Death

0 0.0

Tracheostomy

2 0.2

Other

0.1

Table 13. Parathyroid complications summary

Death

0.1

Seroma

0 0.0

Permanent hypoparathyroidism

0 0.0

Wound infection

0 0.0

Table 12. Thyroid complications summary

Endocrine Surgery Annual Report 2021

Time trends

Thyroid/parathyroid cases 2000–2021 Figure 19 shows the number of elective cases by thyroid-only, parathyroid-only, and both thyroid and parathyroid.

Total operative cases 2000–2021 Figure 18 shows the total number of elective operative cases from 2000 to 2021 (top chart), and the percentage change year-on-year (bottom chart). Over time, the number of cases have generally increased.

Figure 19. Number of thyroid-only, parathyroid-only and both thyroid and parathyroid cases from 2000–2021

Adrenal cases 2005–2021 Figure 20 shows the number of elective adrenal cases from 2005 to 2021.

Figure 18. Total number of operative cases from 2000–2021 (top) and the year-on-year percentage change (bottom)

Figure 20. Number of adrenal cases from 2005–2021

Endocrine Surgery Annual Report 2021

General/Emergency operative cases

Thyroid complications 2000–2021 Figure 21 shows the percentage of thyroid complications since 2000, classified by complication type (permanent RLN palsy and reoperation for haemorrhage). In general, complications have been decreasing over time.

In 2021 there was a total of 213 general/emergency operative cases. The most common procedures were appendicectomy (48.4%) and abscess (20.7%) (Figure 23).

Complications

Figure 21. Thyroid complication rate from 2000–2021

Parathyroid complications 2000–2021 Figure 22 shows the number of parathyroid complications from 2000 to 2021, classified by complication type (permanent RLN palsy and reoperation for haemorrhage). As with thyroid complications, these have also been decreasing.

Figure 23. General/emergency operative cases breakdown

Complications

Figure 22. Parathyroid complication rate from 2000–2021

Endocrine Surgery Annual Report 2021

Glossary

Acknowledgements

Abbreviation

Definition

ANZ

Australia New Zealand

ANZES

Australian New Zealand Endocrine Surgeons

Consultants

Data Managers Dr Ahmad Aniss Eric Jiang

ANZTCR

Australian & New Zealand Thyroid Cancer Registry

A/Prof Anthony Glover Professor Stan Sidhu Clin. A/Prof Mark Sywak

DASO

Data Analysis & Surgical Outcomes Unit

ELN

External Laryngeal Nerve

FLASH

Fostering Leadership Across Systems in Health

Administration Johannes Willemse

IAES

International Association of Endocrine Surgeons

Fellows

IQR

Interquartile Range

Registrars (2021) Dr Jonathan Hew Dr Andrew Kiat Dr Jakob Koestenbauer Dr Zaineb Naseem Dr David Leung Dr Robert Mechera Dr Alexander Papachristos

Report Design and Development

LGA LHD

Local Government Area

Local Health District

Nadine Chidiac Kathy Chung Tim Pollicina

LOS

Length of Stay

Doctor of Medicine

MIP

Minimally Invasive Procedure

miRNA

MicroRNA

MNG

Multinodular Goiter

NSLHD

Northern Sydney Local Health District

NSW

New South Wales

Residents/Interns

PhD

Doctor of Philosophy

Laura Nicholls Ivy Wen Elizabeth Wong Rachel Xuan

PRINS

Psoriasis-susceptibility-related RNA Gene Induced by Stress

qPCR

Quantitative Polymerase Chain Reaction

RACS

Royal Australasian College of Surgeons

REDCap

Research Electronic Data Capture - An online data collection platform to manage online surveys and databases

RLN

Recurrent Laryngeal Nerve

RNA

Ribonucleic Acid

RNSH

Royal North Shore Hospital

Standard Deviation

SET

Surgical Education and Training

Cardiac Surgery Annual Report 2021

Endocrine Surgery Annual Report 2021

Northern Sydney Local Health District Royal North Shore Hospital Reserve Road St Leonards NSW 2065

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