Volume 131, Issue 4 pp. 932-946
Systematic Review

Tracheal Resection in the Management of Thyroid Cancer: An Evidence-Based Approach

Meredith Allen BS

Corresponding Author

Meredith Allen BS

Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A.

Send correspondence to Meredith Allen, BS, Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI, 48309. E-mail: [email protected]

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Aviv Spillinger BS

Aviv Spillinger BS

Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A.

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Khashayar Arianpour MD

Khashayar Arianpour MD

Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.

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Jared Johnson MD

Jared Johnson MD

Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.

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Andrew P. Johnson MD

Andrew P. Johnson MD

Department of Otolaryngology–Head and Neck Surgery, University of Colorado Medical School, Aurora, Colorado, U.S.A.

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Adam J. Folbe MD

Adam J. Folbe MD

Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A.

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Jeffrey Hotaling MD

Jeffrey Hotaling MD

Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.

Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.

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Peter F. Svider MD

Peter F. Svider MD

Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey, U.S.A.

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First published: 28 September 2020
Citations: 15

Editor's Note: This Manuscript was accepted for publication on September 04, 2020

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

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; I2 = 1.85%) airway complications, 2.8% (CI 1.6–3.9; P < .001; I2 = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2–3.1; P < .001; I2 = 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; I2 = 35.26%), 15% (CI 9.6–20.3; P < .001; I2 = 38.2%), 19.7% (CI 13.7–25.8; P < .001; I2 = 28.83%), 74.5% (CI 64.4–84.6; P < .001; I2 = 85.07%). Window resection estimates: 19.8% (CI 6.9–32.8; P < .001; I2 = 18.83%) major complications, 25.6% (CI 5.1–46.1; P < .014; I2 = 84.68%) locoregional recurrence, 15.6% (CI 9.7–21.5; P < .001; I2 = 0%) distal recurrence, 77.1% (CI 58–96.2; P < .001; I2 = 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

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