Mediastinal Goiter from the View of Thoracic Surgery

Abstract

Background: Several definitions were used to describe retrosternal goiter (RSG). The most accepted one describes when ≥50% of the mass portion of the goiter is in the mediastinum. It is considered a surgical challenge because of the difficulties faced during resection and the potential need for an extracervical approach. Objective: It is to present some of the operated cases referred to our Thoracic Surgery Department after multidisciplinary discussion and decision to operate such cases in combined team with ENT/General Surgery with analysis of their data. Materials and Methods: A retrospective analysis of 42 patients who underwent resections in a combined team for RSG between 2018 and 2022 in the theater of Cardiothoracic Surgery, Cairo University Hospitals. The patients were evaluated regarding their demographics, symptoms, level and side of extension in the mediastinum, approach, pathology, and postoperative complications. Results: The mean age was 57.1 years with male: female ratio 1:4.25. The most common symptom was dyspnea in 54% of cases. History of previous thyroid surgery was found in 17(40%) patients. There were 15(36%) patients who had extensions below the aortic arch. Sternal splitting was performed in 18 cases (43%) while thoracotomy was performed in 3cases (7%). Morbidity occurred in 5cases (11.9%) in the form of RLN palsy, phrenic nerve palsy, need for tracheostomy or Montgomery's tube with no postoperative mortality. The extension of RSG beyond the aortic arch and history of previous thyroidectomy were significant calling for extracervical approach. Conclusion: Retrosternal goiter is an indication for surgery to avoid airway compression, malignancy and difficult excision if the operation is delayed.