Surgical Outcomes Following First Rib Resection for Neurogenic Thoracic Outlet Syndrome: A Systematic Review of 1,334 Operated Sides
Introduction Neurogenic thoracic outlet syndrome (NTOS) is the most common subtype of thoracic outlet syndrome and results from compression of the brachial plexus within the thoracic outlet. First rib resection (FRR) is considered the cornerstone of surgical management in patients with refractory symptoms, although…
2026 1,991 reads 0 citations
Review Articles
Surgical Outcomes Following First Rib Resection for Neurogenic Thoracic Outlet Syndrome: A Systematic Review of 1,334 Operated Sides
IntroductionNeurogenic thoracic outlet syndrome (NTOS) is the most common subtype of thoracic outlet syndrome and results from compression of the brachial plexus within the thoracic outlet. First rib resection (FRR) is considered the cornerstone of surgical management in patients with refractory symptoms, although postoperative outcomes remain variably reported. This systematic review aimed to evaluate the outcomes, complications, and recurrence rates of FRR in the management of NTOS.
MethodsA systematic review was conducted using Google Scholar, supplemented by artificial intelligence-assisted searches. Original studies reporting postoperative outcomes following FRR for NTOS were included. Data regarding patient characteristics, surgical approaches, postoperative outcomes, complications, and recurrence were extracted and analyzed descriptively. Comparative analyses between surgical approaches were performed using Chi-square testing.
ResultsNineteen studies involving 1,334 operated sides were included. Most studies were cohort studies (73.68%). Females represented 75.44% of reported patients. Successful postoperative outcomes were observed in 87.08% of analyzable cases. No statistically significant difference in success or recurrence rates was identified between the open approaches. A total of 170 complications were recorded among operated sides managed via the transaxillary approach. Pneumothorax was the most frequently reported complication in both the transaxillary (n = 99, 20.58%) and supraclavicular (n = 7, 2.68%) approaches. The overall recurrence rate was 1.50%.
ConclusionFirst rib resection is a safe and effective surgical intervention for NTOS, yielding favorable outcomes with low recurrence across a broad range of operative approaches. Neither the choice of surgical approach nor the extent of rib resection significantly influences surgical success.
Keywords Surgical decompression Brachial plexus Transaxillary approach Supraclavicular approach Postoperative outcomes Recurrence All subjects
Barw Medical Journal. 2026;4(1):42–54