Thyroid Cancer Management in Contemporary Practice: A Systematic Review and Meta-Analysis of Diagnostic Pathways, Surgical Strategies, Airway Challenges, and Mediastinal Extension.
Ahmed Farouk Ibrahim Koraitim, Mahmoud Mostafa Mohamed, Mohammad Abd Elhameed Alwaseef et al.
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In 30 seconds
This systematic review and meta-analysis synthesized 11 primary studies published between 2021 and 2026, covering 6,142 patients with thyroid cancer and focusing on diagnostic performance, airway management, surgical outcomes, and mediastinal extension. The pooled incidence of difficult airway was 9.4% (95% CI: 6.1-14.2%; I² = 61.3%), and overall surgical morbidity was 21.3% (95% CI: 16.8-26.5%; I² = 72.6%). CT had 61.4% sensitivity and 90.8% specificity for detecting tracheal invasion. The review highlights the perioperative complexity of locally advanced disease.
Key findings
- Difficult airway occurred in a pooled 9.4% of cases (95% CI: 6.1-14.2%; I² = 61.3%).
- Overall surgical morbidity was 21.3% (95% CI: 16.8-26.5%; I² = 72.6%).
- Tracheal invasion affected 28.7% (95% CI: 21.4-37.3%) of locally advanced cases.
- CT sensitivity and specificity for tracheal invasion were 61.4% and 90.8%, respectively.
Why it matters
The pooled estimates describe substantial airway and surgical challenges in complex thyroid cancer, while CT’s moderate sensitivity indicates that imaging may not identify every case of tracheal invasion. These findings can inform risk assessment and multidisciplinary preparation for patients with locally advanced or retrosternal disease, while the heterogeneity across studies warrants caution in applying pooled rates to individual settings.
What to keep in mind
The included studies were heterogeneous, with substantial statistical heterogeneity for difficult airway and surgical morbidity estimates.