Manuscript title: A systematic literature review to compare
clinical outcomes of different surgical techniques for second branchial
cyst removal.
Running title : surgical branchial cyst removal
External funding : noneData available: on requestConflict of interest : no conflict of interest to declare
Word count: Abstract: 247 words, Article: 2426 words
Level of Evidence: Level IIA
5 key points :
- Branchial cysts are the most common branchial anomalies in adults and
early and complete surgical excision is the recommended treatment
- More (temporary) complications occur using endoscopic and
retro-auricular techniques [0-27.3%] than through application of
the conventional technique [0-10.4%].
- Retroauricular and endoscopic surgery results in significantly higher
scar satisfaction in uninfected branchial cysts 3 to 6 months after
surgery in comparison to the conventional technique
- No disease recurrence was reported during (at least) 3 months of
follow up using either conventional surgery or endoscopic/retro
auricular techniques
- Since follow up was short, recurrence rates could be underreported and
scar judgment could be affected. Therefore, no evidence based
treatment advice can be provided and future prospective studies with
long-term follow up (> five years) are indicated.
Abstract:
Aims : During the last two decades, new treatment methods have been
developed for the surgical removal of second branchial cysts which
result in less visible scars. The aim of this systematic review is to
assess which surgical technique for second branchial arch cyst removal
results in the lowest complication and recurrence rates with the highest
scar satisfaction.Methods: Two authors systematically reviewed literature in the
Cochrane, PubMed and EMBASE databases (search date: 1975 to December
23th, 2019) to identify studies comparing surgical outcomes of second
branchial arch cyst removal. Authors appraised selected studies on
directness of evidence and risk of bias. Results are reported according
to Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement.
Results: Out of the 2101 retrieved articles, four articles were
included in the current review including a total of 140 operated cysts.
Only two studies included pre-operatively infected cysts. Follow up
ranged from 3 to 24 months. Complication rates ranged between 0 to
27.3% (conventional: [0-10.4%]; endoscopic/retro auricular:
[0-27.3%]). None of the patients presented with postoperative
recurrence. Significantly higher scar satisfaction was found in adult
patients who underwent endoscopic or retro-auricular hairline incision
cyst removal.
Conclusion: No recurrence of disease occurred during (at least)
3 months of follow up using either conventional surgery or
endoscopic/retro auricular techniques. Although more (temporary)
complications occur using endoscopic and retro-auricular techniques,
patients report a significantly higher scar satisfaction 3 to 6 months
after surgery in comparison to the conventional technique. Future
studies are needed to support these findings.