Esophageal perforation during thyroidectomy: A literature review

Abstract

Aims: This study conducts a comprehensive literature review on esophageal perforation during thyroidectomy for managing benign or neoplastic thyroidal diseases. This article encompasses published cases and studies and focuses on intraoperative esophageal perforation during total or subtotal thyroidectomy. Postoperative complications related to esophageal perforation are also included. Methods: A systematic literature search was performed using PubMed, Embase, and Cochrane databases with keywords including “thyroidectomy,” “esophageal perforation,” “postoperative complication,” “incidence,” “risk factors,” and “management.” Inclusion criteria were studies published in English with a sample size greater than 10 patients. Results: Thirty-eight studies were reviewed, mostly case reports or small case series. The incidence of iatrogenic esophageal perforation during thyroidectomy ranged from 0.1% to 1.5%, with higher rates in minimally invasive and robotic-assisted thyroidectomy compared to open thyroidectomy. Conservative management was successful in 62% of patients, while 38% required surgical repair. Mortality rates varied from 0% to 33% for those undergoing surgical repair. Conclusion: Esophageal perforation during thyroidectomy is rare, particularly with experienced surgeons or in high-volume centers. It is more common in malignant thyroid diseases. Symptoms range from mild to severe, and diagnosis typically involves endoscopy or computed tomography with contrast. Management depends on the perforation’s characteristics and the patient’s condition, with options including direct suturing, endoscopic stenting, and radical surgery with viable flaps. Complications can include prolonged hospitalization and feeding issues.