Systematic review of intermediate and long-term results of thoracic outlet decompression

Thoracic outlet syndrome (TOS) consists of a group of disorders resulting from compression of the neurovascular bundle exiting through the thoracic outlet. TOS can be classified based on the etiology of the pathophysiology: neurogenic (nTOS), venous (vTOS), arterial (aTOS), and mixed (mTOS). The constellation of symptoms a patient may experience vary depending on the structures involved. Due to the wide range of etiologies and presenting symptoms, treatments surrounding TOS also differ. Further, the majority of studies focus on the perioperative and short-term outcomes following surgical decompression for TOS. This systematic review aimed to provide a pooled analysis of studies to better understand the intermediate and long-term outcomes of surgical decompression for TOS. We conducted a systematic literature search in the OVID Medline, EMBASE, and Google Scholar databases that had studied long-term outcomes following surgical decompression for TOS. The inclusion period for studies was from January 2015 to May 2023. The primary outcome was postoperative qDASH scores. A total of 16 studies were included in the final analysis. The differences between post-operative and pre-operative qDASH scores were calculated, when able, and there was a mean overall difference of 33.5 points (95% CI 25.2-41.8, P=.001) after surgical decompression. There was a higher proportion of reported excellent outcomes for patients undergoing intervention for arterial and mixed TOS etiologies; whereas, those with venous and neurogenic etiologies had the lowest reported proportion of excellent outcomes. Patients with neurogenic TOS had the highest proportion of reported poor outcomes. In conclusion, surgical decompression for TOS has favorable long-term outcomes, especially in those with arterial and mixed etiologies.