Endoscopic and Open Surgical Therapeutic Outcomes of Subglottic Stenosis: A Systematic Review

To systematically review and compare therapeutic outcomes among endoscopic and open surgical procedures for subglottic stenosis (SS).

Two independent investigators conducted a systematic literature search using Embase, MEDLINE, and PubMed for studies reporting surgical outcomes of endoscopic (balloon dilation, laser resection) or open surgical procedures (cricotracheal resection, laryngotracheal reconstruction) performed in adult and pediatric populations with SS. Primary outcomes included complications, decannulation success, and revision rates. Quality assessment used Methodological Index for Non-Randomized Studies criteria. Due to substantial heterogeneity, descriptive synthesis with crude aggregated proportions was performed.

Twenty-one studies were included, accounting for 153 children and 2714 adults. Idiopathic stenosis concerned 85% of cases. Among 1508 patients undergoing endoscopic procedures, 36% (95% confidence interval [CI]: 33-38%) required revisions, with decannulation success of 36% (95% CI: 27-46%). For 416 patients undergoing open airway resection, 13% (95% CI: 10-16%) required revisions, with decannulation success of 85% (95% CI: 80-90%). Open airway reconstruction (n = 69) resulted in 39% revisions; decannulation outcomes were incompletely reported. Substantial heterogeneity existed in patient characteristics, surgical techniques, and follow-up duration (3-65.5 months).

Endoscopic and open surgical approaches for SS show different outcome profiles influenced by disease severity, etiology, and patient selection. Endoscopic treatment is less invasive but associated with higher reintervention rates, while open surgery appears more durable in selected cases. However, heterogeneity, incomplete reporting, and confounding by indication limit firm conclusions. Standardized prospective studies are needed.