Avaliação crítica de 33 pacientes com bócio mergulhante tratados cirurgicamente por cervicotomia

Abstract

The possibility of needing a combined access, with neck and chest incisions makes the treatment of substernal goiter a challenge both in the pre-op and the intraoperative. We hereby, discuss a standardization of the surgical technique to minimize the need for a chest approach, making the substernal goiter a surgically treatable disease, through a single neck incision, and with low indices of complication. Aim: to assess the substernal goiter surgically approach through a neck incision and to analyze the surgical complications. Materials and methods: we carried out a historical cohort by retrospective analysis of the charts of patients submitted to thyroidectomy, and 33 of them (10.4%) had substernal goiter. Results: all 33 patients were surgically treated through a neck incision without the need for sternotomy. We did not observe definitive lesions in the inferior laryngeal nerve or definitive hypoparathyroidism. Only 2 patients had recurrent nerve paresis; and 2 patients were re-operated because of a neck hematoma. Conclusion: patients with substernal goiter can be safely treated surgically through a single neck incision, bearing low complication rates.

Does the diameter of the thoracic inlet influence the formation of retrosternal goiter?

“…As surgeons, we agree that CT assists with determining potential complications, thoracic gland size, possible difficulties for anesthesia, and the possibility of an extra-cervical procedure to approach RSG [11][12][13] . Several authors have suggested that goiter extension to the level of the aortic arch, especially when associated with tracheal involvement or displacement of a larger vessel, increases the probability of a sternotomy 1,3,10 .…”

“…Retrosternal (or substernal or intrathoracic) goiter (RSG) was first described by Haller in 1749, and it is defined as growth or spread of the thyroid gland below the plane of the thoracic inlet (TI) 1 . The literature classifies RSG as one that presents more than 50% of its mass lying inferior to the thoracic inlet ( Figure 1).…”

Anatomical and developmental aspects of iatrogenic injury to the right recurrent laryngeal nerve in surgical resections of substernal goiter

“…Approximately 1% of goiters are substernal, accounting for 7% of all mediastinal tumors and for 3-20% of thyroidectomies. In the majority of cases the mass is benign and located in the superior mediastinum (Neves et al, 2009). The exact concept for substernal goiter is not clearly defined, and the literature brings several criteria to classify and define this condition.…”

“…Descriptors like retrosternal, substernal, diving, mediastinal, or intrathoracic associated with the term goiter are used to define enlarged thyroid glands that extend past the thoracic inlet. Some authors consider as substernal the cases in which at least 50% of the gland invades the thoracic cavity or cases in which the gland invade the mediastinum, even in the slightest (Neves et al, 2009). Depending on its origin, substernal goiters can be classified as primary or secondary.…”

Retrosternal Goiter – Cancer Incidence

“…As taxas de malignidade, associada ao BR, estão entre 4 e 16%. 18 Em nosso caso, a neoplasia somente foi constatada por meio do exame histopatológico pós-operatório, não interferindo na conduta.…”