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Frontiers in Oncology 2022This meta-analysis evaluated the short-term safety and efficacy of indocyanine green (ICG) fluorescence in gastric reconstruction to determine a suitable anastomotic...
OBJECTIVES
This meta-analysis evaluated the short-term safety and efficacy of indocyanine green (ICG) fluorescence in gastric reconstruction to determine a suitable anastomotic position during esophagectomy.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020 (PRISMA) were followed for this analysis.
RESULTS
A total of 9 publications including 1,162 patients were included. The operation time and intraoperative blood loss were comparable in the ICG and control groups. There was also no significant difference in overall postoperative mortality, reoperation, arrhythmia, vocal cord paralysis, pneumonia, and surgical wound infection. The ICG group had a 2.66-day reduction in postoperative stay. The overall anastomotic leak (AL) was 17.6% (n = 131) in the control group and 4.5% (n = 19) in the ICG group with a relative risk (RR) of 0.29 (95% CI 0.18-0.47). A subgroup analysis showed that the application of ICG in cervical anastomosis significantly reduced the incidence of AL (RR of 0.31, 95% CI 0.18-0.52), but for intrathoracic anastomosis, the RR 0.35 was not significant (95% CI 0.09-1.43). Compared to an RR of 0.35 in publications with a sample size of <50, a sample size of >50 had a lower RR of 0.24 (95% CI 0.12-0.48). Regarding intervention time of ICG, the application of ICG both before and after gastric construction had a better RR of 0.25 (95% CI 0.07-0.89).
CONCLUSIONS
The application of ICG fluorescence could effectively reduce the incidence of AL and shorten the postoperative hospital stay for patients undergoing cervical anastomosis but was not effective for patients undergoing intrathoracic anastomosis. The application of ICG fluorescence before and after gastric management can better prevent AL.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD:42021244819.
PubMed: 35719988
DOI: 10.3389/fonc.2022.847510 -
International Journal of Surgery... Jan 2024Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and postoperative experience of patients among common surgical methods.
METHODS
The PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2023. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome.
RESULTS
Thirty-two studies comprising 7042 patients were included. Robotic bilateral axillo-breast approach (RBABA) and robotic gasless transaxillary approach (RGAA) retrieved fewer lymph nodes (LNs) than open thyroidectomy (OT). RBABA showed a significantly lower permanent recurrent laryngeal nerve (RLN) palsy rate than OT. According to SUCRA values, endoscopic transoral approach (EOA) ranked the highest in retrieved LNs (0.84), the proportion of stimulated serum thyroglobulin less than 1.0 ng/ml (0.77), and the pain score (0.77). Endoscopic bilateral areola approach (EBAA) ranked the highest in the transient RLN palsy rate (0.72). The endoscopic gasless transaxillary approach (EGAA) ranked the highest in the transient hypoparathyroidism rate (0.78). RBABA ranked the highest in the rate of permanent RLN palsy (0.94) and hypoparathyroidism (0.77). OT ranked the highest in operative time (0.92).
CONCLUSIONS
Each surgical method of total thyroidectomy has benefits and limitations. EOA performed the best in maintaining surgical integrality and reducing the pain score, while taking a long operative time. Generally, RBABA showed the best advantage in protecting parathyroid glands and RLN but with the longest operative time. OT had the best advantage in operative time. Therefore, OT and EOA are ideal methods for patients with a higher risk of central LN metastasis. RBABA and EOA may not be suitable for elderly patients or those with high anesthesia risk.
Topics: Humans; Aged; Thyroidectomy; Bayes Theorem; Network Meta-Analysis; Thyroid Neoplasms; Vocal Cord Paralysis; Hypoparathyroidism; Adenocarcinoma; Pain; Retrospective Studies
PubMed: 37916941
DOI: 10.1097/JS9.0000000000000819 -
Diagnostic Pathology Aug 2023Primary pulmonary hyalinizing clear cell carcinoma (HCCC) is a low-grade salivary gland-type carcinoma. Until now, 23 cases of pulmonary HCCC have been reported.
BACKGROUND
Primary pulmonary hyalinizing clear cell carcinoma (HCCC) is a low-grade salivary gland-type carcinoma. Until now, 23 cases of pulmonary HCCC have been reported.
CASE PRESENTATION
Here, we present a patient with primary pulmonary HCCC along with vocal-cord squamous cell carcinoma (SCC) revealed by biopsy examination. The patient underwent radiotherapy for vocal-cord SCC, followed by right upper lobectomy and lymph node dissection 10 months later. Histology revealed polygonal cells with eosinophilic or clear cytoplasm in the myxoid matrix together with hyaline degeneration. The tumor involved the whole layer of the segmental bronchus and regionally involved the alveolar tissue along with one intrapulmonary lymph node. Targeted RNA sequencing revealed Ewing Sarcoma Breakpoint Region 1 (EWSR1)- activating transcription factor 1 (ATF1) fusion. We analyzed the data on pulmonary malignant tumors between 2000 and 2019 in the Surveillance, Epidemiology, and End Results (SEER) database and reviewed all cases of pulmonary HCCC with EWSR1 fusion by searching PubMed. The results showed that head and neck (HN) adenoid cystic carcinoma (ACC) (47.89%) and HNSCC (22.54%) were the most common carcinomas occurring with pulmonary salivary gland-type malignant tumors. Screening of 24 cases of pulmonary HCCC with EWSR1 fusion revealed that five cases demonstrated lymph node metastases and only two had documented tumor recurrences. HCCC is rare and easily misdiagnosed as SCC, but the treatment regimen differs between pulmonary HCCC and SCC.
CONCLUSIONS
Hence, pulmonary tumors with clear cells must be diagnosed with caution. Next-generation sequencing (NGS) may be useful for diagnosis, especially in cases with a history of squamous cell carcinoma (SCC).
Topics: Humans; Adenocarcinoma, Clear Cell; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Laryngeal Neoplasms; Lung Neoplasms; Neoplasm Recurrence, Local; Salivary Gland Neoplasms
PubMed: 37553667
DOI: 10.1186/s13000-023-01376-y -
BioMed Research International 2016Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and... (Comparative Study)
Comparative Study Meta-Analysis Review
Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and safety of air-Q compared to other airway devices during general anesthesia in pediatric patients by conducting a systematic review and meta-analysis. A total of 10 studies including 789 patients were included in the final analysis. Compared with other supraglottic airway devices, air-Q showed no evidence for a difference in leakage pressure and insertion time. The ease of insertion was significantly lower than other supraglottic airway devices. The success rate of intubation was significantly lower than other airway devices. However, fiberoptic view was better through the air-Q than other supraglottic airway devices. Therefore, air-Q could be a safe substitute for other airway devices and may provide better fiberoptic bronchoscopic view.
Topics: Adolescent; Airway Management; Anesthesia, General; Bias; Child; Child, Preschool; Female; Humans; Infant; Intubation, Intratracheal; Laryngeal Masks; Laryngoscopes; Laryngoscopy; Male; Optical Fibers; Pediatrics; Randomized Controlled Trials as Topic; Risk; Treatment Outcome; Vocal Cords
PubMed: 27419134
DOI: 10.1155/2016/6406391 -
Cureus Jan 2024Direct laryngoscopy (DL) is a modality commonly used in endotracheal intubation (EI). Video laryngoscopy (VL) was introduced to further facilitate the procedure with... (Review)
Review
Direct laryngoscopy (DL) is a modality commonly used in endotracheal intubation (EI). Video laryngoscopy (VL) was introduced to further facilitate the procedure with enhancement in glottic views, which captures the video image of the vocal cords to be projected onto a screen, providing enhanced visualization. This real-time video projection aids in accurately placing the endotracheal tube (ETT) through the vocal cords. In emergency and critical care settings, both laryngoscopes are used for intubations. This study assesses the efficacy of both modalities by comparing success rates in first-attempt tracheal intubation in critically ill patients. PubMed, EMBASE, and Scopus were searched and all randomized controlled trials (RCTs) and observational studies until 2023 were included. Studies included patients in critical care settings undergoing EI under the guidance of either DL or VL. The primary outcome was the first attempt at successful tracheal intubation. The secondary outcomes assessed the comparative safety of DL and VL by comparing the rates of severe hypoxemia, severe hypotension, and cardiac arrest occurring during each modality. P-values were considered of statistical significance if below 0.05. Statistical analysis was performed using RevMan v5.4 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The results were displayed in the form of forest plots. A total of eight studies were included with a total of 5348 patients, with 1780 in the DL group and 3568 in the VL group. Analysis revealed that in emergency situations, the success rate of intubation on the first attempt was significantly higher for VL than DL [81.5% vs 68%; RR= 1.19; 95% CI: 1.10, 1.29; p <0.00001; I2=70%]. There was no significant correlation between VL and severe hypoxemia [13.4% vs 11.6%; RR= 0.99; 95% CI: 0.74, 1.33; p =0.97; I2=46%], severe hypotension [6.09% vs 4.78%; RR:1.19; 95% CI: 0.83, 1.72; p =0.35, I2-15%], and cardiac arrest, [0.8% vs 0.4%; RR= 1.17; 95% CI: 0.37, 3.70]; p =0.79; I2=0%]. Our meta-analysis confirmed that VL has a higher success rate for first-pass intubation than DL. Furthermore, our analysis has shown no significant evidence linking VL to any adverse events.
PubMed: 38322075
DOI: 10.7759/cureus.51720 -
Ear, Nose, & Throat Journal Feb 2021To investigate the indications, efficacy, safety, and outcomes of potassium-titanyl-phosphate (KTP) laser procedures for treatment of laryngeal disease.
OBJECTIVE
To investigate the indications, efficacy, safety, and outcomes of potassium-titanyl-phosphate (KTP) laser procedures for treatment of laryngeal disease.
METHODS
PubMed, Cochrane Library, and Scopus were searched for studies providing information about the indications, efficacy, and safety of both in-office and operative suspension microlaryngoscopy KTP laser procedure in treatment of laryngeal disease. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
RESULTS
Of the initial screened 140 papers, 17 met our inclusion criteria. Six papers involved KTP laser procedures for benign and malignant vocal fold lesions in suspension microlaryngoscopy only, 10 papers focused on only in-office KTP laser procedures for benign vocal fold lesions, and 1 paper included both in-office and suspension microlaryngoscopy procedures. The following lesions may be considered as indications for KTP laser procedures: Reinke's edema, sulcus vocalis, vocal fold hemorrhage, polyp, granuloma, cyst, scar, papillomatosis, dysplasia, leukoplakia, and early vocal fold malignancies. Irrespective of the types of procedure (in-office vs suspension microlaryngoscopy), the KTP laser is associated with a low complication rate and overall good vocal fold vibration recovery. There is an important heterogeneity among studies concerning laser settings, indications, and outcomes used for the assessment of treatment effectiveness. There are no controlled studies directly comparing KTP laser with other lasers (ie, carbon dioxide laser).
CONCLUSION
The use of KTP laser procedures for treatment of laryngeal disease has increased over the past decade, especially for office-based management of vocal fold lesions. Future controlled studies are needed to compare the safety and outcomes of the KTP laser to other techniques.
Topics: Ambulatory Surgical Procedures; Humans; Laryngeal Diseases; Laryngoscopy; Lasers, Solid-State; Otolaryngology; Prospective Studies; Retrospective Studies; Treatment Outcome; Vocal Cords; Voice Quality
PubMed: 31928082
DOI: 10.1177/0145561319899183 -
Pediatric Pulmonology Apr 2019Magnetic Resonance Imaging (MRI) techniques to image the larynx have evolved rapidly into a promising and safe imaging modality, without need for sedation or ionizing...
BACKGROUND
Magnetic Resonance Imaging (MRI) techniques to image the larynx have evolved rapidly into a promising and safe imaging modality, without need for sedation or ionizing radiation. MRI is therefore of great interest to image pediatric laryngeal diseases. Our aim was to review MRI developments relevant for the pediatric larynx and to discuss future imaging options.
METHODS
A systematic search was conducted to identify all morphological and diagnostic studies in which MRI was used to image the pediatric larynx, laryngeal disease, or vocal cords.
RESULTS
Fourteen articles were included: three studies on anatomical imaging of the larynx, two studies on Diffusion Weighted Imaging, four studies on vocal cord imaging and five studies on the effect of anaesthesiology on the pediatric larynx. MRI has been used for pediatric laryngeal imaging since 1991. MRI provides excellent soft tissue contrast and good visualization of vascular diseases such as haemangiomas. However, visualization of cartilaginous structures, with varying ossification during childhood, and tissue differentiation remain challenging. The latter has been partly overcome with diffusion weighted imaging (DWI), differentiating between benign and malignant masses with excellent sensitivity (94-94.4%) and specificity (91.2-100%). Vocal cord imaging evolved from static images focused on vocal tract growth to dynamic images able to detect abnormal vocal cord movement.
CONCLUSION
MRI is promising to evaluate the pediatric larynx, but studies using MRI as diagnostic imaging modality are scarce. New static and dynamic MR imaging techniques could be implemented in the pediatric population. Further research on imaging of pediatric laryngeal diseases should be conducted.
Topics: Child; Humans; Larynx; Magnetic Resonance Imaging
PubMed: 30680950
DOI: 10.1002/ppul.24250 -
The Cochrane Database of Systematic... Aug 2015Total thyroidectomy (TT) and subtotal thyroidectomy (ST) are worldwide treatment options for multinodular non-toxic goitre in adults. Near TT, defined as a postoperative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Total thyroidectomy (TT) and subtotal thyroidectomy (ST) are worldwide treatment options for multinodular non-toxic goitre in adults. Near TT, defined as a postoperative thyroid remnant less than 1 mL, is supposed to be a similarly effective but safer option than TT. ST has been shown to be marginally safer than TT, but it may leave an undetected thyroid cancer in place.
OBJECTIVES
The objective was to assess the effects of total or near-total thyroidectomy compared to subtotal thyroidectomy for multinodular non-toxic goitre.
SEARCH METHODS
We searched the Cochrane Library, MEDLINE, PubMed, EMBASE, as well as the ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was 18 June 2015 for all databases. No language restrictions were applied.
SELECTION CRITERIA
Two review authors independently scanned the abstract, title or both sections of every record retrieved to identify randomised controlled trials (RCTs) on thyroidectomy for multinodular non-toxic goitre for further assessment.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data, assessed studies for risk of bias and evaluated overall study quality utilising the GRADE instrument. We calculated the odds ratio (OR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. A random-effects model was used for pooling data.
MAIN RESULTS
We examined 1430 records, scrutinized 14 full-text publications and included four RCTs. Altogether 1305 participants entered the four trials, 543 participants were randomised to TT and 762 participants to ST. A total of 98% and 97% of participants finished the trials in the TT and ST groups, respectively. Two trials had a duration of follow-up between 12 and 39 months and two trials a follow-up of 5 and 10 years, respectively. Risk of bias across studies was mainly unknown for selection, performance and detection bias. Attrition bias was generally low and reporting bias high for some outcomes. In the short-term postoperative period no deaths were reported for both TT and ST groups. However, longer-term data on all-cause mortality were not reported (1284 participants; 4 trials; moderate quality evidence). Goiter recurrence was lower in the TT group compared to ST. Goiters recurred in 0.2% (1/425) of the TT group compared to 8.4% (53/632) of the ST group (OR 0.05 (95% CI 0.01 to 0.21); P < 0.0001; 1057 participants; 3 trials; moderate quality evidence). Re-intervention due to goitre recurrence was lower in the TT group compared to ST. Re-intervention was necessary in 0.5% (1/191) of TT patients compared to 0.8% (3/379)of ST patients (OR 0.66 (95% CI 0.07 to 6.38); P = 0.72; 570 participants; 1 trial; low quality evidence). The incidence of permanent recurrent laryngeal nerve palsy was lower for ST compared with TT. Permanent recurrent laryngeal nerve palsy occurred in 0.8% (6/741) of ST patients compared to 0.7% (4/543) of TT patients (OR 1.28, (95% CI 0.38 to 4.36); P = 0.69; 1275 participants; 4 trials; low quality evidence). The incidence of permanent hypoparathyroidism was lower for ST compared with TT. Permanent hypoparathyroidism occurred in 0.1% (1/741) of ST patients compared to 0.6% (3/543) of TT patients (OR 3.09 (95% CI 0.45 to 21.36); P = 0.25; 1275 participants: 4 trials; low quality evidence). The incidence of thyroid cancer was lower for ST compared with TT. Thyroid cancer occurred in 6.1% (41/669) of ST patients compared to 7.3% (34/465)of TT patients (OR 1.32 (95% CI 0.81 to 2.15); P = 0.27; 1134 participants; 3 trials; low quality evidence). No data on health-related quality of life or socioeconomic effects were reported in the included studies.
AUTHORS' CONCLUSIONS
The body of evidence on TT compared with ST is limited. Goiter recurrence is reduced following TT. The effects on other key outcomes such as re-interventions due to goitre recurrence, adverse events and thyroid cancer incidence are uncertain. New long-term RCTs with additional data such as surgeons level of experience, treatment volume of surgical centres and details on techniques used are needed.
Topics: Adult; Goiter, Nodular; Humans; Randomized Controlled Trials as Topic; Recurrence; Reoperation; Thyroid Neoplasms; Thyroidectomy; Vocal Cord Paralysis
PubMed: 26252202
DOI: 10.1002/14651858.CD010370.pub2 -
Gland Surgery Oct 2018Despite a number of studies, the optimal timing of completion thyroidectomy is still controversial. This systematic review and meta-analysis aims to compare the outcomes...
BACKGROUND
Despite a number of studies, the optimal timing of completion thyroidectomy is still controversial. This systematic review and meta-analysis aims to compare the outcomes of early versus delayed completion thyroidectomy regarding post-operative complications.
METHODS
We performed a systematic review in electronic databases including: bumped, Scopus, Medline and Google Scholar to identify relevant studies. Eligibility criteria included studies comparing the outcomes of early versus delayed completion thyroidectomy with no language restriction. Publication bias was assessed by funnel plot, and Heterogeneity was assessed using I statistic. Finally, pooled odds ratios (OR) with a 95% confidence interval (CI) was reported for comparing the overall complications rate.
RESULTS
Eventually 7 studies were included. Delayed completion thyroidectomy was found to be associated with significantly lower rates of post-operative complications (OR =1.55; 95% CI, 1.00-2.42; Z=1.95; P=0.05) with low heterogeneity (I=0%, P=0.55), and low risk of publication bias. The rate of transient hypocalcemia and persistent hypocalcemia were 8.97% and 1.52% in early completion thyroidectomy group, and 8.2% and 0.72%, in delayed completion thyroidectomy group. Transient vocal cord paresis occurred in 5.38% of the early CT group versus 3.27% in the delayed CT group.
CONCLUSIONS
This review is the first to summarize the outcome of early verse delayed completion thyroidectomy. The result of our systematic review and meta-analysis suggest that delayed completion thyroidectomy is associated with lower rate of post-operative complications compared to early completion thyroidectomy.
PubMed: 30505767
DOI: 10.21037/gs.2018.09.03 -
Langenbeck's Archives of Surgery Jun 2017Recurrent laryngeal nerve (RLN) injury is one of the most common and detrimental complications following thyroidectomy. Intermittent intraoperative nerve monitoring... (Meta-Analysis)
Meta-Analysis Review
The current state of intermittent intraoperative neural monitoring for prevention of recurrent laryngeal nerve injury during thyroidectomy: a PRISMA-compliant systematic review of overlapping meta-analyses.
PURPOSE
Recurrent laryngeal nerve (RLN) injury is one of the most common and detrimental complications following thyroidectomy. Intermittent intraoperative nerve monitoring (I-IONM) has been proposed to reduce prevalence of RLN injury following thyroidectomy and has gained increasing acceptance in recent years.
METHODS
A comprehensive database search was performed, and data from eligible meta-analyses meeting the inclusion criteria were extracted. Transient, permanent, and overall RLN injuries were the primary outcome measures. Quality assessment via AMSTAR, heterogeneity appraisal, and selection of best evidence was performed via a Jadad algorithm.
RESULTS
Eight meta-analyses met the inclusion criteria. Meta-analyses included between 6 and 23 original studies each. Via utilization of the Jadad algorithm, the selection of best evidence resulted in choosing of Pisanu et al. (Surg Res 188:152-161, 2014). Five out of eight meta-analyses demonstrated non-significant (p > 0.05) RLN injury reduction with the use of I-IONM versus nerve visualization alone.
CONCLUSIONS
To date, I-IONM has not achieved a significant level of RLN injury reduction as shown by the meta-analysis conducted by Pisanu et al. (Surg Res 188:152-161, 2014). However, most recent developments of IONM technology including continuous vagal IONM and concept of staged thyroidectomy in case of loss of signal on the first side in order to prevent bilateral RLN injury may provide additional benefits which were out of the scope of this study and need to be assessed in further prospective multicenter trials.
Topics: Humans; Intraoperative Complications; Intraoperative Neurophysiological Monitoring; Postoperative Complications; Recurrent Laryngeal Nerve Injuries; Thyroidectomy; Vocal Cord Paralysis
PubMed: 28378238
DOI: 10.1007/s00423-017-1580-y