Department of Surgery, School of Medicine, Universidad de Antioquia, Fundación Colombiana de Cancerología-Clínica Vida, Medellin, Colombia.
Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil.
JAMA Otolaryngol Head Neck Surg. 2019 Jun 1;145(6):563-573. doi: 10.1001/jamaoto.2019.0092.
Systematic reviews and meta-analyses are considered the best evidence for clinical decision making. Many reviews of intraoperative neuromonitoring (IONM) in thyroidectomy have conflicting results, owing in large part to methodological quality.
To assess the methodological quality and the causes of heterogeneous results of systematic reviews that compare routine IONM vs visual identification of the recurrent laryngeal nerve (RLN) in patients undergoing thyroidectomy.
A systematic search was performed of MEDLINE (PubMed), Embase, the Cochrane Library, LILACS (Literatura Latino Americana e do Caribe em Ciências da Saúde), Web of Science, and Google from January 1, 1968, through June 30, 2018. Data were analyzed from July 17 to November 30, 2018.
Studies that mentioned performance of a systematic review/meta-analysis during the search period.
Data including study characteristics, type of patients, numbers of nerves at risk, and temporary and definitive RLN paralysis by group were extracted. Data about methodological characteristics, type of statistical analysis and summary estimator, endorsement of systematic review/meta-analysis guidelines, heterogeneity, publication bias, funding, conflict of interest, and statistical analysis were also recorded. The methodological quality was measured with the AMSTAR2 (A Measurement Tool to Assess Systematic Reviews) tool by 2 independent evaluators.
Methodological quality.
The search identified 13 systematic reviews that included patients who underwent open or minimally invasive thyroidectomy, second operations, and a mixture of low- and high-risk procedures. The mean compliance with the AMSTAR2 overall criteria was 53% (range, 11%-83%); with critical criteria, 71% (range, 50%-94%). The percentage of nerves at risk from RCTs was 4.8%. The mean (SD) crude rate of definitive RLN paralysis was 0.81% (0.22%; median, 0.75% [range, 0.53%-1.30%]) in the monitoring group and 1.14% (0.56%; median, 0.96% [range, 0.57%-2.56%]) in the control group.
A substantial number of systematic reviews of IONM in thyroidectomy have conflicting results, but their mean methodological quality is critically low. Design of a systematic review should comply with methodological standards and recommendations to offer relevant and practical information for decision making.
系统评价和荟萃分析被认为是临床决策的最佳证据。许多关于术中神经监测 (IONM) 在甲状腺切除术的综述结果存在冲突，这在很大程度上是由于方法学质量的原因。
评估比较常规 IONM 与视觉识别喉返神经 (RLN) 在甲状腺切除术患者中的系统评价的方法学质量和异质性结果的原因。
从 1968 年 1 月 1 日至 2018 年 6 月 30 日，对 MEDLINE（PubMed）、Embase、Cochrane 图书馆、LILACS（拉丁美洲和加勒比地区健康科学文献）、Web of Science 和 Google 进行了系统检索。数据分析于 2018 年 7 月 17 日至 11 月 30 日进行。
在检索期间提到进行系统评价/荟萃分析的研究。
提取的数据包括研究特征、患者类型、风险神经数量以及每组的暂时性和永久性 RLN 麻痹。还记录了关于方法学特征、统计分析和汇总估计类型、系统评价/荟萃分析指南的认可、异质性、发表偏倚、资金、利益冲突和统计分析的数据。两名独立评估者使用 AMSTAR2（评估系统评价的测量工具）测量方法学质量。
方法学质量。
搜索确定了 13 项系统评价，其中包括接受开放或微创甲状腺切除术、二次手术以及低风险和高风险手术混合的患者。整体符合 AMSTAR2 标准的平均百分比为 53%（范围为 11%-83%）；关键标准的符合率为 71%（范围为 50%-94%）。随机对照试验中风险神经的平均（SD）比例为 4.8%。监测组中永久性 RLN 麻痹的平均（SD）粗发生率为 0.81%（0.22%；中位数为 0.75%[范围为 0.53%-1.30%]），对照组为 1.14%（0.56%；中位数为 0.96%[范围为 0.57%-2.56%]）。
大量关于甲状腺切除术 IONM 的系统评价结果存在冲突，但它们的平均方法学质量很低。系统评价的设计应符合方法学标准和建议，为决策提供相关和实用的信息。
