Preoperative predictors of sternotomy need in mediastinal goiter management

Abstract

Background. The objective of this study was to identify the preoperative risk factors for patients in need of a sternotomy in the management of mediastinal goiters in order to provide better preoperative planning and patient consent.Methods. We analyzed 98 patients who underwent surgery for mediastinal goiters (goiters extending below the thoracic inlet 3 cm with the neck in hyperextension) between 1995 and 2008. Twelve (12.2%) of the patients required a sternotomy. The patients' features were analyzed by the surgical approach performed. Logistic regression analysis was used to study which variables were influencing the surgical strategy. The receiver operating characteristic (ROC) curves were designed when appropriate.Results. Terms such as retrosternal, substernal, intrathoracic, or mediastinal have been used to describe a goiter that extends beyond the thoracic inlet. Although suppression therapy by exogenous thyroxine can reduce the size of the gland by 20% to 30%, 1 the consensus is that the mediastinal goiter is a condition that requires surgical management. Literature reports often stress the need for surgical treatment in relation to compressive symptoms, potential airway compromise, and the possibility of an association with thyroid malignancy. 2-6The mediastinal thyroid can be usually managed through a cervical incision. 7 This approach has been shown to be sufficient in up to 97% of cases. 5 In patients in whom the gland cannot be safely removed through a cervical incision, thyroidectomy may require a thoracic approach to gain adequate exposure and to remove the gland while avoiding dangerous tractions. Unfortunately, there is no clear demarcation of the cases that require a combined approach, and the Correspondence to: G. Pata

Predictive Value of Thyroid Tissue Density in Determining the Patients on Whom Sternotomy Should be Performed

“…There is no consensus when a thoracic approach is required. Several studies suggested that reoperative surgery for a mediastinal thyroid mass, posterior location, and subcarinal extension increase the risk for a sternotomy [9][10][11][12][13][14].…”

Video assisted thoracoscopic thyroidectomy for retrosternal goitre

“…While most of these retrosternal goitres can be excised through a standard cervical collar incision, 4-12% of patients will require an additional thoracic incision such as a manubriotomy, sternotomy, thoracotomy or mediastinotomy. [1][2][3][4][5] Although these incisions facilitate the removal of the goitre, they are invasive and involve disruption of the thoracic skeleton. They may therefore result in significant morbidity including pain, prolonged hospital stay and recovery.…”

Large Retrosternal Goiter: An Otolaryngological Perspective-Case Series and Review of Literature

“…The majority of patients, in addition to neck swelling may present with shortness of breath or stridor. Other symptoms include hoarseness, dysphagia, and about 50% of patients may be asymptomatic [16]. Thyrotoxicosis symptoms were reported in less than 10% of case [17].…”