Lower Rates of Hypocalcemia Following Near-Infrared Autofluorescence Use in Thyroidectomy: A Meta-Analysis of RCTs
Karthik N. Rao,
Renu Rajguru,
Prajwal Dange,
Diana Vetter,
Frederic Triponez,
Iain J. Nixon,
Gregory W. Randolph,
Antti A. Mäkitie,
Mark Zafereo,
Alfio Ferlito
Affiliations
Karthik N. Rao
Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India
Renu Rajguru
Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur 492099, India
Prajwal Dange
Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India
Diana Vetter
Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland
Frederic Triponez
Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland
Iain J. Nixon
Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh EH3 9YL, UK
Gregory W. Randolph
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
Antti A. Mäkitie
Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki University Hospital, 00014 Helsinki, Finland
Mark Zafereo
Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX 77005, USA
Alfio Ferlito
Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
Background: Iatrogenic injury of the parathyroid glands is the most frequent complication after total thyroidectomy. Objective: To determine the effectiveness of near-infrared autofluorescence (NIRAF) in reducing postoperative hypocalcemia following total thyroidectomy. Methods: PubMed, Scopus, and Google Scholar databases were searched. Randomised trials reporting at least one hypocalcemia outcome following total thyroidectomy using NIRAF were included. Results: The qualitative data synthesis comprised 1363 patients from nine randomised studies, NIRAF arm = 636 cases and non-NIRAF arm = 637 cases. There was a statistically significant difference in the overall rate of hypocalcemia log(OR) = −0.7 [(−1.01, −0.40), M-H, REM, CI = 95%] and temporary hypocalcemia log(OR) = −0.8 [(−1.01, −0.59), M-H, REM, CI = 95%] favouring the NIRAF. The difference in the rate of permanent hypocalcemia log(OR) = −1.09 [(−2.34, 0.17), M-H, REM, CI = 95%] between the two arms was lower in the NIRAF arm but was not statistically significant. Conclusions: NIRAF during total thyroidectomy helps in reducing postoperative hypocalcemia. Level of evidence—1.
