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Evolution of the endoscopic modified Lothrop procedure: A systematic review and meta‐analysis
Author(s) -
Shih LiangChun,
Patel Vishal S.,
Choby Garret W.,
Nakayama Tsuguhisa,
Hwang Peter H.
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26794
Subject(s) - medicine , cohort , confidence interval , meta analysis , cohort study , surgery
Objective Since first described in the 1990s, the endoscopic modified Lothrop procedure (EMLP) has been the subject of a growing body of literature. We performed a review to compare indications and outcomes of EMLP in an early cohort of publications (1990–2008) versus a contemporary cohort (2009–2016) and compare outcomes associated with follow‐up ≥2 years versus <2 years. Data Sources PubMed, SCOPUS and Cochrane databases. Review Methods An English‐language search of the PubMed and Ovid databases was conducted to identify publications from 1990 to 2016 reporting clinical outcomes of EMLP. Meta‐analysis was performed using Statistical Analysis System 9.4. Results A total of 1,205 patients were abstracted from 29 articles with a mean follow‐up of 29.1 ± 10.3 months. The overall rate of significant or complete symptom improvement was 86.5% (95% confidence interval [CI]: 84.2%‐88.7%). The overall patency rate was 90.7% (95% CI: 89.1%‐92.3%), with a revision rate of 12.6% (95% CI: 10.6%‐14.3%). Compared to the early cohort, patients in the contemporary cohort underwent EMLP more often for tumors ( P < .001), had higher rates of complete or significant symptom improvement (90.0% vs. 82.6 %, P < .001); and trended toward greater patency rates (92.1% vs. 88.6%, P = .052). Compared to the short‐term follow‐up cohort, the long‐term cohort showed no differences in symptom improvement or patency, but the revision rate was higher (14.5% vs. 9.2%, P = .016). Conclusions In the last decade, EMLP has been performed more frequently for tumors. Recent studies have demonstrated improved symptom outcomes and a trend toward improved patency rates. The revision rate increased significantly when follow‐up exceeded 2 years. Laryngoscope , 128:317–326, 2018