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Nasereldin M, Lefkovitz Z, Epelbaum O. Titan in the Thorax: Fatal Substernal Goiter. Arch Bronconeumol 2024; 60:381-382. [PMID: 38604877 DOI: 10.1016/j.arbres.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Affiliation(s)
| | - Zvi Lefkovitz
- Department of Radiology, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA.
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Sarin V, Singh D, Rana U, Chopra I. Surgical Resection of Retrosternal Goitre: The Four-Finger Technique. Indian J Otolaryngol Head Neck Surg 2023; 75:3014-3020. [PMID: 37982133 PMCID: PMC10653281 DOI: 10.1007/s12070-023-03891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/17/2023] [Indexed: 11/21/2023] Open
Abstract
Retrosternal goitre (RSG) is a thyroid gland with more than 50% of its mass located below the thoracic inlet. Pre-operative Computed Tomography can visualise the anatomical relations between the RSG and each mediastinal component, and the level of extension. Most cases of RSG can be resected via the cervical approach, as the thoracic approach carries a greater risk of complications. We describe a four finger technique for total thyroidectomy in five cases of RSG through a neck incision, without the need for a sternotomy. The recurrent laryngeal nerve (RLN) was identified early in the Baehr's triangle. The thyroid was mobilised in the neck by ligation of the feeding vessels and separated from the tracheal attachments. The retrosternal portion was then delivered into the neck by blunt dissection, keeping two fingers of each hand close to the thyroid gland. The RLN and parathyroids were identified early in the surgery to avoid the complications of hoarseness and hypoalcemia, respectively.
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Affiliation(s)
- Vanita Sarin
- Department of Otorhinolaryngology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Divya Singh
- Department of Otorhinolaryngology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Uday Rana
- Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Ishita Chopra
- Pt. BD Sharma University of Health Sciences, Rohtak, India
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Retrosternal Goitre: Anatomical Aspects and Technical Notes. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030349. [PMID: 35334525 PMCID: PMC8951771 DOI: 10.3390/medicina58030349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
Abstract
Background and Objectives: surgery for substernal goitre is still debated in the literature, due to the wide range of surgical options. This article outlines the findings of our extensive experiences, which include 264 cases of patients with “goitre plongeant“, and compares postoperative complications, despite surgical approaches. Material and Methods: preoperative planning and anatomical landmarks are described to determine the potential need of a combined approach. The surgical procedure is described, along with some stratagems, to ensure that the operation is completed safely. A statistical analysis of complications and the length of stay, with a comparison of cervicotomy and combined access, was performed using the Pearson chi-square significance test. Results: 264 patients underwent thyroid surgery for substernal goitre. The Kocher incision was the surgical approach chosen in 256 patients (96.6%), while an accessory incision was performed in 8 patients (3.4%). The necessity to use a two-fold surgical access was linked to a higher rate of postoperative complications (p-value < 0.01). The average length of stay (LOS) for cervicotomy was 2 days (1−3 days), while the average LOS was 5 days (4−7 days) (p-value = n.s.) for combined access. Conclusions: cervicotomy should be the gold standard technique for exploring intrathoracic goitre with a digital dissection, which, in almost all cases, enables the externalization of the mediastinal portion associated. Sternotomy is related to a higher rate of complications, so it should be performed only in selected cases. Management in large-volume centres may be more appropriate.
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Nesti C, Wohlfarth B, Borbély YM, Kaderli RM. Case Report: Modified Thoracoscopic-Assisted Cervical Resection for Retrosternal Goiter. Front Surg 2021; 8:695963. [PMID: 34179070 PMCID: PMC8219883 DOI: 10.3389/fsurg.2021.695963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: The treatment of choice for retrosternal goiters (RSG) is surgical resection to relieve symptoms and rule out malignancy. Although the majority of RSG can be removed by a cervical approach only, an extracervical approach (e.g., sternotomy, thoracotomy or thoracoscopy) may be required. Herein, we describe a refined thoracoscopic-assisted cervical two-team RSG resection without thoracoscopic mediastinal dissection. Technique: A 57-year-old man presented with a large RSG with posterior mediastinal extension (PME) and extensive peritumoral vascularization. Due to its extension below the aortic arch and its small connection with the right thyroid lobe, a combined cervical and thoracoscopic approach was intended. The endocrine surgery unit performed the cervical mobilization of the right thyroid lobe, while the thoracic surgery unit gently pushed the mediastinal tumor through the thoracic inlet without performing mediastinal dissection. This allowed a safe visualization of the inserting vessels by the endocrine surgery team at the neck, followed by a stepwise division of the vessels and resection of the retrosternal nodule through the cervical access. Comment: The described approach is indicated for RSG with posterior mediastinal extension, anteroposterior dimension smaller than the thoracic inlet and inaccessibility from a cervical approach only. This minimally invasive approach is associated with a faster recovery, decreased morbidity and postoperative pain, shorter hospital stay and better cosmetic results.
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Affiliation(s)
- Cédric Nesti
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benny Wohlfarth
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yves M Borbély
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Reto M Kaderli
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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Fiorelli RKA, Duarte AJV, Quadros Teixeira A, Montenegro TS, Portari Filho PE, Morard MRS, da Silva Ascenção AM, Oliveira CAB, Novellino P. Anatomical and developmental aspects of iatrogenic injury to the right recurrent laryngeal nerve in surgical resections of substernal goiter. Anat Rec (Hoboken) 2021; 304:1242-1254. [DOI: 10.1002/ar.24629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Aline Quadros Teixeira
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Thiago Scharth Montenegro
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Pedro Eder Portari Filho
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Maria Ribeiro Santos Morard
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | | | | | - Pietro Novellino
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
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Van Slycke S, Simons AS, Van Den Heede K, Van Crombrugge P, Tournoy K, Simons P, Vermeersch H, Brusselaers N. Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study. Updates Surg 2021; 73:1-10. [PMID: 33779950 PMCID: PMC8397680 DOI: 10.1007/s13304-021-01027-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
Objective Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy. Methods In a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500). Results An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy. Level of evidence IV Supplementary Information The online version contains supplementary material available at 10.1007/s13304-021-01027-1.
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Affiliation(s)
- S Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
| | - A-S Simons
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Group of Biomedical Sciences, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - K Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - P Van Crombrugge
- Department of Endocrinology, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - K Tournoy
- Department of Pneumology, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Department of Internal Medicine and Paediatrics, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - P Simons
- Department of Radiology, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - H Vermeersch
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Plastic and Reconstructive Surgery, Department of Human Structure and Repair, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - N Brusselaers
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Department of Microbiology, Tumour and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Tomtebodavagen 16, 17165, Stockholm, Sweden. .,Global Health Institute, Antwerp University, Campus Drie Eiken, Gouverneur Kinsbergencentrum, Doornstraat 331, 2610, Wilrijk, Belgium.
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Anikin V, Welman K, Asadi N, Dalal P, Reshetov I, Beddow E. Retrosternal goiter in thoracic surgical practice. Khirurgiia (Mosk) 2021:20-26. [PMID: 34941205 DOI: 10.17116/hirurgia202112120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate and optimize surgical approaches to the management of retrosternal goiter. MATERIAL AND METHODS A cohort retrospective single-center study included 56 patients aged 68.3±9.8 years with retrosternal goiter who underwent surgery between 2004 and 2019. Right-sided goiter was diagnosed in 16 cases, left-sided goiter in 21 patients, bilateral goiter in 19 patients. Palpable neck mass was found in 17 (30.4%), stridor in 16 (28.6%), thyrotoxicosis in 4 (7.1%) and recurrent laryngeal nerve palsy in 2 (3.6%) cases. X-ray signs of tracheal compression were detected in 43 (76.8%) patients, deviation in 26 (46.4%) patients. Resection through cervical collar incision was performed in 40 (71.4%) patients. Additional sternotomy was required in 11 (19.6%) patients, 1 (1.8%) patient required collar incision and right anterior mediastinotomy. Right-sided posterolateral thoracotomy without collar incision was performed in 1 (1.8%) patient with a suspected mediastinal teratoma. Three patients underwent median sternotomy only because of preoperative diagnosis of teratoma in one and thymoma in two patients. RESULTS There was no perioperative mortality. Transient vocal changes occurred in 3 (5.4%) patients, recurrent laryngeal nerve palsy in 3 (5.4%), atrial fibrillation in 2 (3.6%), wound complications in 2 (3.6%), left phrenic nerve palsy in 1 (1.8%), transient hypocalcaemia in 1 (1.8%) and persistent hypothyroidism in 1 (1.8%) patient. Hospital-stay ranged from 2 to 12 (5.5±2.0) days. Multinodular goiter was found in 53 (94.6%) patients, diffuse goiter in 1 (1.8%), ectopic thyroid in 1 (1.8%) and oncocytic tumor in 1 (1.8%) patient. One (1.8%) patient underwent simultaneous resection of RSG via a collar incision and right-sided VATS upper lobectomy for primary lung cancer. One (1.8%) patient also underwent simultaneous resection of RSG via collar incision and right-sided VATS subcarinal lymph node biopsy for coexistent lymphoma. Mean vertical length of goiter in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. Mean weight of specimens was 162.3 g in patients with collar incisions and 312.5 g in the sternotomy group. Sternotomy was required in 14 (25%) patients. CONCLUSION Resection of retrosternal goiter is more commonly performed via cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the need for sternotomy. Surgical outcomes are not affected by surgical approach. Simultaneous thoracic interventions for a coexistent pathology in patients with RSG may be considered. Further research of minimally invasive interventions for RSG resection is required.
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Affiliation(s)
- V Anikin
- Harefield Hospital of the Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield, UK
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K Welman
- Harefield Hospital of the Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield, UK
| | - N Asadi
- Harefield Hospital of the Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield, UK
| | - P Dalal
- Harefield Hospital of the Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield, UK
| | - I Reshetov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E Beddow
- Harefield Hospital of the Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield, UK
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Macedo SS, Teixeira M, Correia A, Cabral C. Substernal Goiter: a case to remember. ACTA ACUST UNITED AC 2020; 66:109-111. [PMID: 32428142 DOI: 10.1590/1806-9282.66.2.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022]
Abstract
Goiter is a localized or generalized thyroid hypertrophy. It can remain within the cervical region or grow down until it invades the mediastinum. The signs and symptoms depend on the size and location of the goiter. Although drugs and radioactive iodine are often used to treat thyroid disease, the presence of symptomatic substernal goiter is a clear indication for surgery. Death or postoperative complications rarely occur. We present a case of a 71-year-old man with recurrent thyroid pathology in the form of substernal goiter and hyperthyroidism even after partial thyroidectomy. The importance of this relates to the clinical evolution, volume, and location of the goiter as well as the surgical and pharmacological approach.
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Affiliation(s)
- Sara Simões Macedo
- . Department of Internal Medicine. Centro Hospitalar Tondela-Viseu,E.P.E. Viseu, Portugal
| | - Mónica Teixeira
- . Department of Internal Medicine. Centro Hospitalar Tondela-Viseu,E.P.E. Viseu, Portugal
| | - Andreia Correia
- . Department of Internal Medicine. Centro Hospitalar Tondela-Viseu,E.P.E. Viseu, Portugal
| | - Cátia Cabral
- . Department of Internal Medicine. Hospital Trofa Saúde Vila Real. Vila Real, Portugal
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Cui R, Yu J, Han ZY, Liu FY, Yu XL, Liang P. Ultrasound-Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2883-2891. [PMID: 30900322 DOI: 10.1002/jum.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To preliminarily evaluate the safety, effectiveness, and feasibility of microwave ablation (MWA) for substernal goiter (SSG) in select patients and to provide a relevant treatment reference for further studies. METHODS From April 2017 to December 2017, 10 patients with SSG were treated by MWA. All patients were followed for at least 3 months to observe the therapeutic effects and complications. Therapeutic effects were assessed at follow-up for the relief of patients' symptoms, resolution of the cosmetic grade, and volume reduction rate (VRR) of SSG. Possibly related factors for the 3-month VRR of the nodules were analyzed. RESULTS The study included 9 female patients and 1 male patient with a mean age ± SD of 56.8 ± 10.1 years (range, 34-70 years). The mean volume of the nodules was 52.9 ± 27.9 mL (range, 23.7-122.6 mL). The nodule volume was significantly reduced at the 3-month follow-up (17.5 ± 9.5 mL; P < .05). The mean 3-month VRR of the index nodule was 66.7% ± 7.1%. A higher ablated portion-to-nodule ratio 1 day after MWA predicted a higher 3-month VRR (Spearman r = 0.646; P = .044). The mean symptom score (from 4.5 ± 1.7 to 1.5 ± 1.0; P = .005) and cosmetic grade (from 3.3 ± 0.5 to 2.2 ± 0.4; P = .004) declined significantly 3 months after the procedure. No complications or unexpected side effects were observed. CONCLUSIONS Our preliminary results support the effectiveness and safety of MWA for local control of SSG. This technology can be applied in select patients with SSG who are ineligible for surgery.
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Affiliation(s)
- Rui Cui
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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A Large Substernal Goiter that Extended to Both Sides of the Thorax. Case Rep Surg 2018; 2018:6107982. [PMID: 30533243 PMCID: PMC6247568 DOI: 10.1155/2018/6107982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/25/2018] [Indexed: 12/04/2022] Open
Abstract
Most substernal goiters can be managed through the transcervical approach, but a sternotomy is required in some cases. This report is about a large substernal goiter, which was resected via a transcervical and full sternotomy approach. The patient was a 57-year-old female, who visited our hospital for surgical treatment for a large substernal goiter. Computed tomography of the neck and chest revealed that the substernal goiter extended to both sides of the thorax and had compressed the trachea. We performed total thyroidectomy safely via a transcervical and full sternotomy approach. No postoperative complications occurred, except transient hypocalcemia. A histopathological examination did not reveal any malignancy, and the lesion was diagnosed as an adenomatous goiter. Most substernal goiters can be managed through the transcervical approach, but a full sternotomy is required when a substernal goiter extends to both sides of the thorax and/or has a larger diameter than the thoracic inlet or airway constriction is revealed. A full sternotomy provides excellent exposure and can help reduce the risk of complications, such as recurrent laryngeal nerve palsy and injuries to major blood vessels.
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Tostado KVC, VelÁZquez-Fernandez D, Chapa MÓN, Pantoja MillÁN JP, Salazar MS, Herrera MF. Substernal Goiter: Correlation between Grade and Surgical Approach. Am Surg 2018. [DOI: 10.1177/000313481808400235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Substernal goiter is defined as a thyroid growth beyond the thoracic inlet. Using the cross-section imaging CT system, it can be classified into three grades. The aim of the study was to validate the surgical approach and the occurrence of postoperative complications with substernal goiter extension in our patient population. From a total of 1145 patients who underwent thyroid surgery at our institution in a 15-year period, 60 patients with substernal goiter were included. Clinical features and demographics, degree of extension, surgical details, and complications were analyzed. Mean ± SD age of the patients was 58 ± 14.7 years and 88 per cent were females. According to the cross-section imaging CT system 61.7 per cent were grade I,23.3 per cent grade II, and 15 per cent grade III. Total thyroidectomy was performed in 78.3 per cent of the patients, subtotal thyroidectomy in 18.3 per cent, and lobectomy in 3.3 per cent. The cervical approach was sufficient to perform 96.7 per cent of the thyroidectomies, requiring partial sternotomy in only two patients with grade III substernal goiter. Patients with grade III substernal goiter had a higher risk for postoperative dysphonia (OR = 14.29, IC95% 1.14-178.9, P = 0.03), which occurred in three patients (two transient and one permanent). Transitory hypoparathyroidism was present in 20 patients (33.3%) and did not correlate with goiter extension. Most substernal goiters can be resected through a cervical approach, with relatively low morbidity. Postoperative dysphonia was directly related to the extension of the goiter. Few cases with grade III goiters require a partial sternotomy.
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Affiliation(s)
| | | | - MÓNica Chapa
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
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Welman K, Heyes R, Dalal P, Hough S, Bunalade M, Anikin V. Surgical Treatment of Retrosternal Goitre. Indian J Otolaryngol Head Neck Surg 2017; 69:345-350. [PMID: 28929066 DOI: 10.1007/s12070-017-1151-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/27/2017] [Indexed: 11/27/2022] Open
Abstract
This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.
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Affiliation(s)
- Kiera Welman
- Department of Thoracic Surgery, The Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, London, UB9 6JH UK
| | - Richard Heyes
- Department of Otolaryngology, Head and Neck Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, London, UK
| | - Paras Dalal
- Department of Thoracic Surgery, The Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, London, UB9 6JH UK
| | - Sarah Hough
- Department of Thoracic Surgery, The Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, London, UB9 6JH UK
| | - Marciano Bunalade
- Department of Thoracic Surgery, The Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, London, UB9 6JH UK
| | - Vladimir Anikin
- Department of Thoracic Surgery, The Royal Brompton and Harefield Hospital NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, London, UB9 6JH UK
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Brenet E, Dubernard X, Mérol JC, Louges MA, Labrousse M, Makeieff M. Assessment and management of cervico-mediastinal goiter. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:409-413. [PMID: 28668317 DOI: 10.1016/j.anorl.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cervico-mediastinal goiter is a particular entity from the point of view of thyroid surgery. Its volume, hardness and intrathoracic extension require the surgeon to adapt technique and perform a painstaking preoperative work-up, so as to draw up fully-fledged plan. CT is now indispensable, to anticipate risks and determine whether sternotomy is needed. Surgery seems to induce more postoperative complications than in conventional surgery, although they can be reduced by retrograde dissection of the inferior laryngeal nerve and downward dissection of the posterior side of the lobe to optimize control of adjacent structures. This surgery requires optimal teamwork between all of the specialties involved in patient management: medical, radiological, anesthesiological and surgical.
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Affiliation(s)
- E Brenet
- Département d'otorhinolaryngologie et chirurgie cervico-faciale, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - X Dubernard
- Département d'otorhinolaryngologie et chirurgie cervico-faciale, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - J C Mérol
- Département d'otorhinolaryngologie et chirurgie cervico-faciale, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M A Louges
- Département d'otorhinolaryngologie et chirurgie cervico-faciale, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Labrousse
- Département d'otorhinolaryngologie et chirurgie cervico-faciale, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Makeieff
- Département d'otorhinolaryngologie et chirurgie cervico-faciale, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Khan MN, Goljo E, Owen R, Park RCW, Yao M, Miles BA. Retrosternal Goiter. Otolaryngol Head Neck Surg 2016; 155:568-74. [DOI: 10.1177/0194599816649583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/22/2016] [Indexed: 11/16/2022]
Abstract
Objective Retrosternal goiters pose a significant challenge in determining the indications and appropriate approach for surgical removal while limiting postoperative morbidity and mortality. The objective of this study is to use the National Surgical Quality Improvement Program (NSQIP) database to compare outcomes of transcervical and transthoracic approaches for retrosternal goiter removal and to review the literature regarding the varying indications for the 2 surgical approaches. Study Design Administrative database analysis. Setting NSQIP database. Subjects and Methods The NSQIP database was queried for all cases of retrosternal thyroid: 2716 patients were included, which represents one of the largest data reviews of patients with retrosternal thyroid pathology who underwent surgery. Data were analyzed to examine morbidity and mortality of the cervical and transthoracic approaches. Results Patient demographics and preoperative comorbidities were similar between groups. Patients undergoing a transthoracic approach experienced increased rates of unplanned intubations and need for transfusion and length of stay postoperatively. Conclusions A transthoracic approach is associated with increased rates of several critical postoperative morbidities, and the data indicate the potential of increased overall mortality. Given equivalent retrosternal extension, a transcervical approach should be attempted whenever anatomically possible, regardless of pathology.
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Affiliation(s)
- Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Erden Goljo
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Randall Owen
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
- Department of General Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Mike Yao
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Brett A. Miles
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
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Moten AS, Thibault DP, Willis AW, Willis AI. Demographics, disparities, and outcomes in substernal goiters in the United States. Am J Surg 2016; 211:703-9. [PMID: 26813846 DOI: 10.1016/j.amjsurg.2015.11.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Disparities distinguishing patients with substernal goiters from nonsubsternal goiters have not been thoroughly described. METHODS The National Inpatient Sample database was used to compare patients who underwent substernal thyroidectomy years 2000 to 2010 with those who underwent thyroidectomy for nonsubsternal goiter. RESULTS A total of 110,889 patients underwent thyroidectomy for goiter (5,525 substernal and 105,364 nonsubsternal). Substernal thyroidectomy patients were older, more likely to be Black or Hispanic and to have Medicare insurance. They had a higher comorbidity index, were more likely to be admitted emergently and to have postoperative complications such as hemorrhage/hematoma, pneumothorax, pulmonary embolism, and hypocalcemia/hypoparathyroidism. Furthermore, substernal thyroidectomy patients had 73% increased odds of death during admission than nonsubsternal thyroidectomy patients. CONCLUSIONS Substernal goiters present a distinct type of goiter with identifiable patient-level characteristics and an increased risk of postoperative complications and death. Earlier identification and treatment of goiters may allow earlier interventions at a stage when risks are reduced.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Dylan P Thibault
- University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
| | - Allison W Willis
- University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
| | - Alliric I Willis
- Thyroid and Parathyroid Surgery Program, Department of Surgery, Thomas Jefferson University, 1100 Walnut St., Suite 500, Philadelphia, PA, USA.
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Al Hashemy A, Gallo R, Shah MT, Al Faifi A, Al Amir A, Al Shraim M, Ezzat N, Rabie ME. Giant intrathoracic goitre: The challenges. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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