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Yankov G, Alexieva M, Yamakova Y, Kyuchukov D, Mekov E. Surgical management of anterior mediastinal tumors of thyroid origin: a comprehensive analysis of approaches, techniques, and outcomes. J Cardiothorac Surg 2024; 19:350. [PMID: 38907269 PMCID: PMC11191202 DOI: 10.1186/s13019-024-02831-7] [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] [Received: 07/22/2023] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND This manuscript aims to describe the symptoms, demographics, surgical approaches and techniques, the volume of surgical interventions, histological results, intra- and postoperative complications, and postoperative results in patients with anterior mediastinal tumors of thyroid origin (AMTTO). METHODS Twenty patients with AMTTO were operated between 2017 and 2021. Fifteen were women and 5 were men. The mean age was 66.8 years. RESULTS The most common histology was nodular micro- and macrofollicular goiter (15/20, 75%). Kocher cervicotomy (65%) was the preferred approach. Total thyroidectomy was performed in 95% of patients. Intraoperative complications were identified in 25% (5/20), and in 2 patients a tracheostomy was required. Early postoperative complications were established in 65% and the most common was unilateral transient recurrent nerve paresis or paralysis and dysphonia (25%). CONCLUSIONS Commonly resection of AMTTO is a challenge due to its complexities associated with high-risk cases, emphasizing the need for experienced centers in managing such cases.
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Affiliation(s)
- Georgi Yankov
- Department of Respiratory Diseases, Medical University - Sofia, UMHAT 'St. Ivan Rilski'15, 'Acad. Ivan Geshov' Blvd, 1431, Sofia, Bulgaria
| | - Magdalena Alexieva
- Department of Respiratory Diseases, Medical University - Sofia, UMHAT 'St. Ivan Rilski'15, 'Acad. Ivan Geshov' Blvd, 1431, Sofia, Bulgaria
| | - Yordanka Yamakova
- Department of Anesthesiology and Intensive Care, Medical University - Sofia, Sofia, Bulgaria
| | - Dimitar Kyuchukov
- Cardiovascular Surgery Department, Medical University - Sofia, Sofia, Bulgaria
| | - Evgeni Mekov
- Department of Respiratory Diseases, Medical University - Sofia, UMHAT 'St. Ivan Rilski'15, 'Acad. Ivan Geshov' Blvd, 1431, Sofia, Bulgaria.
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Akinci O, Aygan S, Inci E, Aydin H, Akinci O, Guzey D, Dural AC. Computed Tomography Findings Affecting the Decision of Sternotomy in Substernal Goiter. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:305-311. [PMID: 37900343 PMCID: PMC10600595 DOI: 10.14744/semb.2023.25307] [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: 03/09/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 10/31/2023]
Abstract
Objectives Although thyroidectomy is completed with a cervical incision in most patients with substernal goiter (SG), sternotomies may be required occasionally. The purpose of this study is to examine computed tomography (CT) findings that may predict the need for sternotomy in SG surgery. Methods Neck-thoracic CT images of patients who underwent total thyroidectomy with the diagnosis of SG between 2013 and 2022 were retrospectively examined. The patients (n=41) were divided into two groups: sternotomies (n=6) and cervical (n=35). Preoperative pathological data, CT findings, and postoperative complications of the patients were recorded. Results The total thyroid volume of the sternotomy group (280.75±127.01 mm3) was significantly greater than that of the cervical group (155.38±74.18 mm3) (p=0.015). The retrosternal thyroid volume (mm3), thyroid craniocaudal, and anterior-posterior dimensions (mm) were significantly greater in the sternotomy group (p=0.001, p<0.001, and p=0.004, respectively). While the majority of mediastinal extension degrees in the cervical group were grade 1 (80%), grade 2 (83%) predominated in the sternotomy group (p=0.001). Conclusion The radiological findings of total thyroid volume, retrosternal thyroid tissue volume, retrosternal thyroid length, thyroid anterior-posterior dimension, and mediastinal extension degree on CT are valuable in predicting the decision to perform a sternotomy in SG surgery.
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Affiliation(s)
- Ozlem Akinci
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Sinan Aygan
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Ercan Inci
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Husnu Aydin
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Ozan Akinci
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Deniz Guzey
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Cem Dural
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
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Phillips A, Calcott S, Rahmani MJH. Out of sight, out of mind: retrosternal goitre as a rare cause of breathlessness. Br J Hosp Med (Lond) 2022; 83:1. [DOI: 10.12968/hmed.2021.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandra Phillips
- Department of Health and Aging, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, East Sussex, UK
| | - Samuel Calcott
- Department of Health and Aging, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, East Sussex, UK
| | - Muhammad JH Rahmani
- Department of Health and Aging, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, East Sussex, UK
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Okomayin AA, Dongo A, Tagar E, Odion C, Akerele M, Omosofe F. Management of a huge intrathoracic goitre in a rural specialist hospital in Nigeria-Case report and review of literature. Niger J Clin Pract 2021; 24:1749-1754. [PMID: 34782518 DOI: 10.4103/njcp.njcp_101_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Retrosternal goiter is expectedly a common presentation in rural African communities due to long periods of neglect. The treatment of choice is surgical - commonly via a trans-cervical incision. A few require an extra-cervical surgical approach and multidisciplinary management as reported in this case performed in a rural specialist hospital in Nigeria.
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Affiliation(s)
- A A Okomayin
- Department of Surgery, General Surgery Unit, Irrua, Edo State, Nigeria
| | - A Dongo
- Department of Surgery, General Surgery Unit, Irrua, Edo State, Nigeria
| | - E Tagar
- Department of Surgery, General Surgery Unit, Irrua, Edo State, Nigeria
| | - C Odion
- Department of Surgery, General Surgery Unit, Irrua, Edo State, Nigeria
| | - M Akerele
- Cardiothoracic Surgery Unit, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - F Omosofe
- Department of Anaesthesia, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
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Sulaiman A, Lutfi A, Ikram M, Fatimi S, Bin Pervez M, Shamim F, Abbas SA, Iftikhar H. Tracheomalacia after thyroidectomy for retrosternal goitres requiring sternotomy- a myth or reality? Ann R Coll Surg Engl 2021; 103:504-507. [PMID: 34192497 DOI: 10.1308/rcsann.2021.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia are conflicting, with some suggesting a high rate and other large cohorts in which no tracheomalacia is reported. The aim of our study was to assess the incidence and factors associated with tracheomalacia after thyroidectomy in patients with retrosternal goitres requiring sternotomy at a high-volume tertiary care referral centre. METHODS A longitudinal cohort study was conducted from January 2011 to December 2019. All adult patients who underwent thyroidectomy with sternotomy were included. Tracheomalacia was considered when tracheal rings were soft compared with other parts (proximal or distal) of the trachea and required either tracheostomy or resection with anastomosis. The decision to perform a tracheostomy or to administer continuous or bilevel positive airway pressure postoperatively was made depending on the degree of tracheomalacia. Logistic regression analysis was used to assess factors associated with tracheomalacia. RESULTS We evaluated 40 patients who underwent thyroidectomy with sternotomy. The mean age of our cohort was 48.7 ± 11.3 years and the population was predominantly female (67.5%). One patient required tracheal resection with anastomosis, and two patients required tracheostomy. Multivariable logistic regression analysis did not reveal any patient- or thyroid-related factor significantly associated with the development of tracheomalacia in our cohort. CONCLUSIONS The incidence of tracheomalacia after thyroidectomy with sternotomy appears to be very low. However, the occurrence of tracheomalacia after thyroidectomy in cases of large goitre is possible and hence worrisome.
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Affiliation(s)
- A Sulaiman
- Aga Khan University Hospital, Karachi, Pakistan
| | - A Lutfi
- Aga Khan University Hospital, Karachi, Pakistan
| | - M Ikram
- Aga Khan University Hospital, Karachi, Pakistan
| | - S Fatimi
- Aga Khan University Hospital, Karachi, Pakistan
| | | | - F Shamim
- Aga Khan University Hospital, Karachi, Pakistan
| | - S A Abbas
- Aga Khan University Hospital, Karachi, Pakistan
| | - H Iftikhar
- Aga Khan University Hospital, Karachi, Pakistan
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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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Oh SL, Chia CLK, Ooi OC, Sonawane V, Rao AD, Singaporewalla R. A rare case of ectopic retrosternal goiter. Clin Case Rep 2021; 9:1849-1852. [PMID: 33936601 PMCID: PMC8077326 DOI: 10.1002/ccr3.3610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022] Open
Abstract
It is important for the clinician to be familiar with interpreting a variety of radiological modalities that provide vital information that will aid in the preoperative planning, counseling, and subsequent management of patients with retrosternal goiter.
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Affiliation(s)
- Shen Leong Oh
- Department of General SurgeryKhoo Teck Puat HospitalSingaporeSingapore
| | | | - Oon Cheong Ooi
- Department of Cardiac, Thoracic and Vascular SurgeryNational University Heart HospitalSingaporeSingapore
| | - Vikram Sonawane
- Department of EndocrinologyKhoo Teck Puat HospitalSingaporeSingapore
| | - Anil D. Rao
- Department of General SurgeryKhoo Teck Puat HospitalSingaporeSingapore
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A Case of a Young Woman with Cervico-Mediastinal Malignant Goiter. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
The main treatment in nearly every case of thyroid cancer is surgery. The exception often refers to anaplastic carcinoma because this cancer is already widespread at the time of diagnosis. Most of the cases are treated with thyroidectomy, but small tumors that spread inside the thyroid gland might be treated by lobectomy. Intrathoracic goiter accounts for 5.8% of all mediastinal masses. On the other hand, the incidence of thyroid malignancy in cervico-mediastinal thyroid masses is 7,7%. In such cases, total thyroidectomy with en block removal of the mediastinal portion of the gland is the treatment of choice. We present a case of a 34-year-old woman with cervico-mediastinal malignant goiter.
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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