Allen Meredith, Spillinger Aviv, Arianpour Khashayar, Johnson Jared, Johnson Andrew P, Folbe Adam J, Hotaling Jeffrey, Svider Peter F
Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A.
Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Laryngoscope. 2021 Apr;131(4):932-946. doi: 10.1002/lary.29112. Epub 2020 Sep 28.
Determine the effect of patient demographics and surgical approach on patient outcomes after tracheal resection in the management of thyroid cancer.
Systematic review and meta-analysis.
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.
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 = 1.85%) airway complications, 2.8% (CI 1.6-3.9; P < .001; I = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2-3.1; P < .001; I = 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 = 35.26%), 15% (CI 9.6-20.3; P < .001; I = 38.2%), 19.7% (CI 13.7-25.8; P < .001; I = 28.83%), 74.5% (CI 64.4-84.6; P < .001; I = 85.07%). Window resection estimates: 19.8% (CI 6.9-32.8; P < .001; I = 18.83%) major complications, 25.6% (CI 5.1-46.1; P < .014; I = 84.68%) locoregional recurrence, 15.6% (CI 9.7-21.5; P < .001; I = 0%) distal recurrence, 77.1% (CI 58-96.2; P < .001; I = 78.77%) overall survival.
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.
确定患者人口统计学特征和手术方式对甲状腺癌气管切除术后患者预后的影响。
系统评价和荟萃分析。
使用PubMed、Embase和Cochrane图书馆对文献进行系统评价，以确定接受气管切除的甲状腺癌患者。使用随机效应荟萃分析确定患者人口统计学特征、呈现的结果、并发症和预后的合并估计值。
96项涉及1179例患者的相关研究符合纳入标准。荟萃分析合并并发症发生率：气道并发症为1.7%（置信区间[CI]0.8 - 2.5；P <.001；I = 1.85%），双侧喉返神经麻痹为2.8%（CI 1.6 - 3.9；P <.001；I = 13.34%），吻合口裂开为2.2%（CI 1.2 - 3.1；P <.001；I = 6.72%）。环形切除合并估计的主要并发症、局部区域复发、远处复发、总生存率：14.1%（CI 8.3 - 19.9；P <.001；I = 35.26%），15%（CI 9.6 - 20.3；P <.001；I = 38.2%），19.7%（CI 13.7 - 25.8；P <.001；I = 28.83%），74.5%（CI 64.4 - 84.6；P <.001；I = 85.07%）。开窗切除估计值：主要并发症为19.8%（CI 6.9 - 32.8；P <.001；I = 18.83%），局部区域复发为25.6%（CI 5.1 - 46.1；P <.014；I = 84.68%），远处复发为15.6%（CI 9.7 - 21.5；P <.001；I = 0%），总生存率为77.1%（CI 58 - 96.2；P <.001；I = 78.77%）。
侵袭性甲状腺癌的治疗可能需要气管切除以实现局部区域控制。然而，术后并发症并非微不足道，因此在围手术期向患者咨询时不能忽视这种风险。《喉镜》，131:932 - 946，2021年。
