Depth of mediastinal extension can predict sternotomy need for substernal thyroid goiters

A critical update on the management of retrosternal goiter

“…The most important study that has corroborated these factors was published in 2019: in a cohort of 237 RGs where 29 (12.2%) required sternotomy, on multivariate logistic regression analysis, extension below the aortic arch (OR 10.84), an iceberg shape (OR 59.30), and previous neck surgery (OR 4.83) were all significantly associated with an extra-cervical approach 66 . 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 .…”

Case Report: A pyramidal lobe coexisting with a left-sided thyroid goiter displacing trachea and esophagus: A cadaveric finding with clinical implications

“…18 Thus, in the current case, the CCA and IJV were displaced laterally rather than posteriorly. Linhares et al 19 recorded the prevalence of substernal extension of the TGo in 10% of patients (109/1080 patients who underwent surgical resection for multinodular TGo). Patients with substernal TGo and progressive enlargement and/or compressive symptoms should undergo surgical excision.…”