[Restenosis rate after surgical and endoscopic treatment of cicatricial tracheal stenosis: a systematic review and meta-analysis].

Objective

To estimate the rate of restenosis after surgical and endoscopic treatment of acquired benign tracheal stenosis in adults with separate analyses by approach, etiology, and follow-up. MATERIAL AND

Methods

Systematic searching was performed in PubMed/MEDLINE, EuropePMC, Cochrane CENTRAL, eLibrary.ru, BASE, LILACS databases and trial registries (2005-2025). Cohorts ≥100 patients (primary set) and 50-99 (sensitivity set) were eligible. Two reviewers performed blinded screening and extraction (Cohen's κ=0.808); the risk of bias was assessed with ROBINS-I. Proportions were pooled under random effects with stratification by approach, etiology and follow-up.

Results

Primary set comprised 14 cohorts (3.213 patients; 690 events); sensitivity set - 25 cohorts. Heterogeneity was high (I²=98.0%). The pooled restenosis rate was 16.8% (95% CI 13.5-20.6; 95% PI 1.1-78.2). There were the following values depending on approach: circumferential tracheal resection 7.8%, mixed 10.0%, isolated endoscopy 47.6% (p<0.0001). Idiopathic subglottic cicatricial stenosis of the trachea comprised 58.9%, PITS+PTTS - 5.7%, mixed/other - 15.3% (p<0.0001). Sensitivity set yielded 22.3%. The estimate was robust to sequential cohort exclusion (16.5-25.2%). Egger's test showed funnel asymmetry (p=0.019) opposite to classical small-study pattern; trim-and-fill imputed no missing studies.

Conclusion

The pooled 16.8% does not predict individual outcome; only the stratified estimate is clinically usable. Direct surgical-versus-endoscopic comparison on retrospective data is unsound because patient selection differs by approach. In idiopathic subglottic stenosis, the true restenosis rate under adequate prospective follow-up exceeds the primary-set estimate.