# APBA Kısa Özet

This systematic review and meta-analysis synthesizes data from 11 studies encompassing 6,142 thyroid cancer patients published between 2021 and 2026. It consolidates critical perioperative risks, diagnostic performance metrics, and surgical outcomes, with a specific focus on locally advanced disease involving the trachea, recurrent laryngeal nerve, and mediastinal structures.

# Çalışma neyi araştırdı?

The research aimed to systematically evaluate and quantitatively synthesize evidence on diagnostic performance, perioperative airway management, surgical outcomes, and mediastinal extension in thyroid cancer. The review focused on the integrated burden of diagnostic limitations, airway complications, surgical outcomes, and mediastinal involvement, which are often reported in fragmented and heterogeneous studies. The review specifically targeted locally advanced and complex thyroid cancer cases reported between January 2021 and January 2026.

# Yöntem

The study was conducted in accordance with PRISMA 2020 guidelines and the MOOSE framework. A comprehensive search was performed across PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase. Studies included were original investigations reporting perioperative airway complications, surgical morbidity, diagnostic accuracy for tracheal invasion, or recurrent laryngeal nerve injury in thyroid cancer patients. Eligibility criteria required data on the specified outcomes. Data extraction focused on pooled incidence rates, sensitivity, specificity, and surgical outcomes. Statistical pooling was performed using random-effects models, and heterogeneity was assessed using the I² statistic.

# Temel bulgular

  • Difficult Airway Incidence: The pooled incidence of a difficult airway was 9.4% (95% CI: 6.1–14.2%), with moderate to substantial statistical heterogeneity (I² = 61.3%).
  • Overall Surgical Morbidity: The pooled overall surgical morbidity was 21.3% (95% CI: 16.8–26.5%), indicating significant perioperative risk (I² = 72.6%).
  • Tracheal Invasion Prevalence: Tracheal invasion was present in 28.7% (95% CI: 21.4–37.3%) of locally advanced cases.
  • Mediastinal Extension: Retrosternal extension requiring thoracic surgical access occurred in 18.3% (95% CI: 12.7–25.7%) of cases.
  • Diagnostic Accuracy of CT: Computed tomography demonstrated a pooled sensitivity of 61.4% and a specificity of 90.8% for detecting tracheal invasion.
  • Recurrent Laryngeal Nerve Injury: Injury rates ranged from 2.8% to 5.9% for transient injury and 0.5% to 1.4% for permanent injury across the included studies.

# Bulgular ne anlama geliyor?

The meta-analysis reveals that thyroid cancer surgery, particularly in locally advanced cases, carries a significant perioperative risk profile. The incidence of a difficult airway (9.4%) and overall surgical morbidity (21.3%) exceed rates typically seen in standard thyroidectomy. The high prevalence of tracheal invasion (28.7%) in locally advanced disease underscores the need for meticulous pre-operative planning and consideration of invasive tumor spread. Furthermore, the relatively low sensitivity of CT (61.4%) for detecting tracheal invasion suggests that CT alone may be insufficient for accurate staging; multimodal diagnostic approaches, such as endosonography or MRI, may be warranted. The range of recurrent laryngeal nerve injury (transient 2.8–5.9%, permanent 0.5–1.4%) highlights the technical complexity of the surgery and the critical importance of intraoperative neuromonitoring and surgical expertise.

# Klinik önem

These findings have substantial clinical implications for thyroid cancer management. The 9.4% difficult airway rate supports the recommendation for routine pre-operative airway assessment in all thyroid cancer patients. Given the limited CT sensitivity, clinicians should maintain a high index of suspicion for tracheal invasion and consider advanced imaging or direct visualization in suspicious cases. The documented nerve injury rates emphasize the need for meticulous surgical technique and the routine use of intraoperative nerve monitoring to optimize functional outcomes. However, the high heterogeneity observed across studies necessitates cautious interpretation; clinical decisions should be individualized based on patient-specific factors and surgeon experience.

# Sınırlılıklar

This meta-analysis is subject to several limitations. There was moderate to substantial statistical heterogeneity across pooled outcomes (I² = 61.3% for difficult airway, I² = 72.6% for morbidity), which may reflect true clinical diversity or methodological differences between studies. The search was limited to primary studies published between January 2021 and January 2026, potentially excluding older or more recent data. Computed tomography demonstrated relatively low sensitivity (61.4%) for detecting tracheal invasion, indicating that diagnostic performance may vary with protocol and operator expertise. Additionally, the included original studies did not consistently report detailed patient characteristics (e.g., tumor size, surgical volume, or hospital type), limiting the ability to conduct subgroup analyses on factors influencing outcomes. These limitations underscore the need for future high-quality, prospective studies with standardized reporting to refine the evidence base.