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Article: Systematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy
Title | Systematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy |
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Authors | |
Keywords | Intra-operative neuro-monitoring Re-operation Recurrent laryngeal nerve palsy Thyroid cancer Thyroidectomy |
Issue Date | 2017 |
Publisher | Elsevier 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? |
Abstract | Introduction: 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 Identifier | http://hdl.handle.net/10722/237761 |
ISSN | 2023 Impact Factor: 12.5 2023 SCImago Journal Rankings: 2.895 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Wong, KP | - |
dc.contributor.author | Mak, KL | - |
dc.contributor.author | Wong, CKH | - |
dc.contributor.author | Lang, HHB | - |
dc.date.accessioned | 2017-01-20T02:28:09Z | - |
dc.date.available | 2017-01-20T02:28:09Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | International Journal of Surgery, 2017, v. 38, p. 21-30 | - |
dc.identifier.issn | 1743-9191 | - |
dc.identifier.uri | http://hdl.handle.net/10722/237761 | - |
dc.description.abstract | Introduction: 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.language | eng | - |
dc.publisher | Elsevier Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijsu | - |
dc.relation.ispartof | International Journal of Surgery | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Intra-operative neuro-monitoring | - |
dc.subject | Re-operation | - |
dc.subject | Recurrent laryngeal nerve palsy | - |
dc.subject | Thyroid cancer | - |
dc.subject | Thyroidectomy | - |
dc.title | Systematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy | - |
dc.type | Article | - |
dc.identifier.email | Wong, KP: kpwongb@hku.hk | - |
dc.identifier.email | Wong, CKH: carlosho@hku.hk | - |
dc.identifier.email | Lang, HHB: Blang@hku.hk | - |
dc.identifier.authority | Wong, KP=rp02007 | - |
dc.identifier.authority | Wong, CKH=rp01931 | - |
dc.identifier.authority | Lang, HHB=rp01828 | - |
dc.description.nature | postprint | - |
dc.identifier.doi | 10.1016/j.ijsu.2016.12.039 | - |
dc.identifier.scopus | eid_2-s2.0-85007545299 | - |
dc.identifier.hkuros | 271043 | - |
dc.identifier.volume | 38 | - |
dc.identifier.spage | 21 | - |
dc.identifier.epage | 30 | - |
dc.identifier.isi | WOS:000397030800013 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 1743-9159 | - |