Which risk factors are associated with stomal recurrence after total laryngectomy for laryngeal cancer? A meta-analysis of the last 30 years.
patients with stomal recurrence after total laryngectomy
tumor subsite (supraglottic vs. subglottic and glottic vs. subglottic), T stage
preoperative tracheotomy
stomal recurrence
Abstract
Stomal recurrence is a troublesome complication after total laryngectomy. Despite a large number of studies having been performed, there is still controversy about which risk factors are most significant for the development of stomal recurrence. The objective of the present meta-analysis was to analyze the potential factors leading to stomal recurrence after total laryngectomy. PubMed, Web of Science, Cochrane Library, and Ovid databases were systematically searched using multiple search terms. Eighteen studies with 6462 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. The results showed that, tumor subsite (supraglottic vs. subglottic, RR=0.292, 95% CI 0.142-0.600, p=0.001; glottic vs. subglottic, RR=0.344, 95% CI 0.175-0.676, p=0.002), T stage (RR=0.461, 95% CI 0.286-0.742, p=0.001), preoperative tracheotomy (RR=1.959, 95% CI 1.500-2.558, p<0.001) were the high-risk factors associated with the development of stomal recurrence. From the results of our study, tumor subsite, T stage and preoperative tracheotomy were the significant risk factors for stomal recurrence. Methodologically high-quality comparative investigations are needed for further evaluation. A recorrência estomal pós-laringectomia total e é uma complicação de difícil manejo. Apesar de um grande número de estudos ter sido feito, ainda há controvérsias sobre quais fatores de risco são mais significativos para o seu desenvolvimento. O objetivo da presente meta-análise foi analisar os fatores potenciais para recorrência estomal após a laringectomia total. As bases de dados PubMed, Web of Science, Cochrane Library e Ovid foram sistematicamente pesquisadas com vários termos de busca. Dezoito estudos com 6.462 pacientes foram identificados. A qualidade da evidência foi avaliada pelo Os resultados mostraram que o subsítio tumoral (supraglótico vs. subglótico, RR = 0,292, IC 95% 0,142 ± 0,600, Com base nos resultados de nosso estudo, o subsítio do tumor, o estágio T e a traqueotomia pré-operatória foram fatores de risco significativos para recorrência estomal. São necessárias investigações comparativas metodologicamente de alta qualidade para maior avaliação.