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Article: Systematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy

TitleSystematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy
Authors
Issue Date2017
PublisherElsevier Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijsu
Citation
International Journal of Surgery, 2017, v. 38, p. 21-30 How to Cite?
AbstractIntroduction: Use of intra-operative neuro-monitoring (IONM) during high-risk thyroidectomy has been suggested to decrease the rate of recurrent laryngeal nerve (RLN) palsy. However, current evidences were mixed and there was no large-scale study concluding its benefit. We evaluated the role of IONM in reducing RLN palsy during high-risk thyroidectomy and identified which high-risk subgroup would be most benefited. Methods: A systemic review was performed to identify studies comparing the use of IONM and visual identification of RLN alone (VA) during high-risk thyroidectomy, namely re-operation, thyroidectomy for malignancy, thyrotoxicosis or retrosternal goitre. Rate of RLN palsy was presented in terms of number of nerve-at-risk (NAR). Meta-analysis on overall high-risk thyroidectomy and subgroups were performed using fixed or random-effects model. Results: Ten articles were eligible for final analysis. There were 4460 NARs in VA group and 6155 NARs in IONM group. Comparing to VA, IONM had lower rate of overall [4.5% vs. 2.5%, Odd ratio (OR): 1.40, 95% confidence interval (CI): 1.12–1.79, p = 0.003] and temporary [3.9% vs. 2.4%; OR: 1.47, 95% CI: 1.07–2.00, p = 0.016] RLN palsy in overall high-risk thyroidectomies. On subgroup analysis, although numbers of NARs were less than minimal numbers required for a statistical powered study (2.1%–72.7%), use of IONM decreased the rate of overall RLN palsy during re-operation (7.6% vs. 4.5%, OR: 1.32, p = 0.021) and temporary RLN palsy during thyroidectomy for malignancy (3.1% vs. 1.6%, OR: 1.90, p = 0.026). Use of IONM tended to have a lower rate of overall RLN palsy during thyroidectomy for malignancy than VA alone. (3.5% vs. 2.1%, p = 0.050). Conclusions: Selective use of IONM during high-risk thyroidectomy decreased the rate of overall RLN palsy. IONM should be applied during re-operative thyroidectomy and thyroidectomy for malignancy.
Persistent Identifierhttp://hdl.handle.net/10722/237761
ISSN
2019 Impact Factor: 3.357
2015 SCImago Journal Rankings: 0.652
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, KP-
dc.contributor.authorMak, KL-
dc.contributor.authorWong, CKH-
dc.contributor.authorLang, HHB-
dc.date.accessioned2017-01-20T02:28:09Z-
dc.date.available2017-01-20T02:28:09Z-
dc.date.issued2017-
dc.identifier.citationInternational Journal of Surgery, 2017, v. 38, p. 21-30-
dc.identifier.issn1743-9191-
dc.identifier.urihttp://hdl.handle.net/10722/237761-
dc.description.abstractIntroduction: Use of intra-operative neuro-monitoring (IONM) during high-risk thyroidectomy has been suggested to decrease the rate of recurrent laryngeal nerve (RLN) palsy. However, current evidences were mixed and there was no large-scale study concluding its benefit. We evaluated the role of IONM in reducing RLN palsy during high-risk thyroidectomy and identified which high-risk subgroup would be most benefited. Methods: A systemic review was performed to identify studies comparing the use of IONM and visual identification of RLN alone (VA) during high-risk thyroidectomy, namely re-operation, thyroidectomy for malignancy, thyrotoxicosis or retrosternal goitre. Rate of RLN palsy was presented in terms of number of nerve-at-risk (NAR). Meta-analysis on overall high-risk thyroidectomy and subgroups were performed using fixed or random-effects model. Results: Ten articles were eligible for final analysis. There were 4460 NARs in VA group and 6155 NARs in IONM group. Comparing to VA, IONM had lower rate of overall [4.5% vs. 2.5%, Odd ratio (OR): 1.40, 95% confidence interval (CI): 1.12–1.79, p = 0.003] and temporary [3.9% vs. 2.4%; OR: 1.47, 95% CI: 1.07–2.00, p = 0.016] RLN palsy in overall high-risk thyroidectomies. On subgroup analysis, although numbers of NARs were less than minimal numbers required for a statistical powered study (2.1%–72.7%), use of IONM decreased the rate of overall RLN palsy during re-operation (7.6% vs. 4.5%, OR: 1.32, p = 0.021) and temporary RLN palsy during thyroidectomy for malignancy (3.1% vs. 1.6%, OR: 1.90, p = 0.026). Use of IONM tended to have a lower rate of overall RLN palsy during thyroidectomy for malignancy than VA alone. (3.5% vs. 2.1%, p = 0.050). Conclusions: Selective use of IONM during high-risk thyroidectomy decreased the rate of overall RLN palsy. IONM should be applied during re-operative thyroidectomy and thyroidectomy for malignancy.-
dc.languageeng-
dc.publisherElsevier Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijsu-
dc.relation.ispartofInternational Journal of Surgery-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleSystematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy-
dc.typeArticle-
dc.identifier.emailWong, KP: kpwongb@hku.hk-
dc.identifier.emailWong, CKH: carlosho@hku.hk-
dc.identifier.emailLang, HHB: Blang@hku.hk-
dc.identifier.authorityWong, KP=rp02007-
dc.identifier.authorityWong, CKH=rp01931-
dc.identifier.authorityLang, HHB=rp01828-
dc.description.naturepostprint-
dc.identifier.doi10.1016/j.ijsu.2016.12.039-
dc.identifier.hkuros271043-
dc.identifier.volume38-
dc.identifier.spage21-
dc.identifier.epage30-
dc.identifier.isiWOS:000397030800013-
dc.publisher.placeUnited Kingdom-

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