Difficult airway after late postoperative bleeding in a case of total thyroidectomy, tracheal resection and reconstruction

Comparison of delayed bleeding to immediate bleeding following thyroidectomy

It is important to identify risk factors for post-thyroidectomy bleeding requiring airway intervention or reoperation. Therefore, we aimed to compare the characteristics of patients with postoperative bleeding after thyroid surgery according to the period until reoperation. We conducted a retrospective study analyzing data between April 2009 and July 2022 and included 126 patients who had postoperative bleeding. The patients were grouped according to the period between thyroidectomy and reoperation due to bleeding (0 day, 1-7 days, > 7 days). We performed among-group comparisons of patient characteristics and surgical aspects, including the extent of surgery. The ratios of male-female and lateral neck dissection were higher in the post-operative bleeding group than in the group without bleeding. In the analysis of patients with postoperative bleeding, grouped according to period between thyroidectomy and reoperation, there was a significant among-group difference in the male-female ratio. The male sex was positively correlated with the reoperation period. Further, the reoperation period was also positively correlated with total thyroidectomy and lateral neck dissection and the operation time showed a significant among-group difference. Our results indicate that the male sex and lateral neck dissection are risk factors for postoperative bleeding after thyroidectomy. Furthermore, male sex, total thyroidectomy, and lateral neck dissection are risk factors for delayed bleeding. Therefore, clinicians should consider these factors for interventions against immediate or delayed bleeding after thyroidectomy.

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

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.