Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series

Abstract

Background The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. Materiels and methods Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. Results 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. Conclusions With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality.

A critical update on the management of retrosternal goiter

“…For the sake of completeness, another group has suggested the presence of an inflammatory component in the excised RG as a predictor for sternotomy (only on univariate analysis and in a small series) 67 , while in another series of 109 RGs, only the part extending beyond the sternal notch into the mediastinum would predict sternotomy (univariate only, odds ratio 3.43, confidence interval 1.65-6.41), with a sensitivity of 94% and specificity of 86.5% when it is more than 5 cm 68 . Unmeasurable aspects such as the surgeon's expertise do however exist since there are case series where RG cases below the aortic arch or in the posterior mediastinum were reported to be completely excised through a purely transcervical approach 69 .…”