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Tracheal Resection in the Management of Thyroid Cancer: An Evidence‐Based Approach
Author(s) -
Allen Meredith,
Spillinger Aviv,
Arianpour Khashayar,
Johnson Jared,
Johnson Andrew P.,
Folbe Adam J.,
Hotaling Jeffrey,
Svider Peter F.
Publication year - 2021
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.29112
Subject(s) - medicine , confidence interval , meta analysis , thyroid cancer , thyroid carcinoma , demographics , anastomosis , thyroid , dehiscence , gastroenterology , surgery , demography , sociology
Objective Determine the effect of patient demographics and surgical approach on patient outcomes after tracheal resection in the management of thyroid cancer. Study Design Systematic review and meta‐analysis. Methods Systematic review of literature was performed using PubMed, Embase, and Cochrane Library to identify patients with thyroid carcinoma who underwent tracheal resection. Pooled estimates for patient demographics, presenting findings, complications, and outcomes are determined using random‐effects meta‐analyses. Results Ninety‐six relevant studies encompassing 1,179 patients met inclusion criteria. Meta‐analysis pooled rates of complications: 1.7% (confidence interval [CI] 0.8–2.5; P < .001; I 2 = 1.85%) airway complications, 2.8% (CI 1.6–3.9; P < .001; I 2 = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2–3.1; P < .001; I 2 = 6.72%) anastomotic dehiscence. Circumferential resection pooled estimates major complications, locoregional recurrence, distal recurrence, overall survival: 14.1% (CI 8.3–19.9; P < .001; I 2 = 35.26%), 15% (CI 9.6–20.3; P < .001; I 2 = 38.2%), 19.7% (CI 13.7–25.8; P < .001; I 2 = 28.83%), 74.5% (CI 64.4–84.6; P < .001; I 2 = 85.07%). Window resection estimates: 19.8% (CI 6.9–32.8; P < .001; I 2 = 18.83%) major complications, 25.6% (CI 5.1–46.1; P < .014; I 2 = 84.68%) locoregional recurrence, 15.6% (CI 9.7–21.5; P < .001; I 2 = 0%) distal recurrence, 77.1% (CI 58–96.2; P < .001; I 2 = 78.77%) overall survival. Conclusion Management of invasive thyroid carcinoma may require tracheal resection to achieve locoregional control. Nevertheless, postoperative complications are not insignificant, and therefore this risk cannot be overlooked when counseling patients perioperatively. Laryngoscope , 131:932–946, 2021