Rib-sparing scalenotomy in thoracic outlet syndrome treatment: A systematic review and meta-analysis

The majority of neurogenic thoracic outlet syndrome (NTOS) surgery still involves removal of the first rib. A rib-sparing procedure has also been found to give a good result, but no meta-analysis has been published about this procedure. Also, from a financial point of view, it is important to know what kind of results have been obtained in the treatment of NTOS with rib-sparing surgery. Our opinion is that first-rib resection (FRR) surgeries, which contain more complications and require a longer recovery time, are performed too often these days, if the same result is achieved with rib-sparing surgery.

We accomplished a systematic review and meta-analysis to find out the outcome of rib-sparing NTOS surgery, collecting studies on rib-sparing supraclavicular scalenotomy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using appropriate databases.

Of 1354 studies, 18 studies met our inclusion criteria. The mean study sample size was 58, and the mean patient age at surgery was 35.8 years. All studies reported long-term outcomes, with the mean follow-up time of 49 months. All reported fewer patient complaints after surgical TOS treatment. In our meta-analysis, improvement to Derkash's excellent/good classifications was achieved in 71% (95% confidence interval (CI) = 64.4% to 76.4%, I² = 73.0%). The heterogeneity noted in the systematic review showed no significant moderation by gender, age, or follow-up time. The studies included had a low risk of publication bias, with most failing to use validated evaluation methods.

According to this analysis, the rib-sparing surgical treatment of NTOS is beneficial to most patients and relatively safe. Still, future studies should accommodate validated thoracic outlet scales.Type of study / level of evidence:Therapeutic IV.