Sternotomy for substernal goitre: an otolaryngologist's perspective

Burns, Paul; Doody, Jaime; Timon, Conrad

doi:10.1017/s0022215107000047

Cited by 26 publications

(19 citation statements)

References 11 publications

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“…9 Burns et al performed a sternotomy in only 3/140 patients with SSG, since, in their opinion, the more significant factors contributing to the need to perform sternotomy are CT evidence of adherence to the surrounding mediastinal tissues and extension of the goiter to, or below, the aortic arch. 25 White et al , based on a systematic review of the literature, suggested that sternotomy is more likely to be performed in the presence of a primary substernal goiter or a mass larger than the thoracic inlet. 11 Ahmed et al used extension beyond the aortic knuckle on chest X-ray as their landmark for the depth of substernal extension.…”

Section: Discussionmentioning

confidence: 99%

Substernal Goiter: When is a Sternotomy Required?

Coşkun

Yıldırım

Erkan

2014

International Surgery

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The presence of substernal goiter is, per se, an indication for surgical management. Surgical approach of substernal goiter can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The aim of this study was to identify the preoperative predictors of a sternotomy in the management of substernal goiter in order to provide better preoperative planning and patient consent. Between 2005 and 2012, 665 patients were referred to our clinic for thyroidectomy, 42 patients (6.3%) had substernal goiter and were included in this study. All substernal goiters were treated surgically, 38 (90.5%) by a cervical approach and 4 (9.5%) by full median sternotomy. All surgeries were successful, with no major postoperative complications. Minor postoperative complications of transient hypocalcemia and transient paralysis of the recurrent laryngeal nerve occurred in 5 (11.9%) and 2 (4.7%) cases, respectively. Indication of median sternotomy was as follows: extension of goiter below the aortic arch, large thyroid tissue extending towards tracheal bifurcation, and ectopic thyroid tissue in the mediastinum. Substernal goiter can be removed through a cervical incision, but on rare occasions, a median sternotomy may be required.

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Section: Discussionmentioning

confidence: 99%

Substernal Goiter: When is a Sternotomy Required?

Coşkun

Yıldırım

Erkan

2014

International Surgery

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“…Several authors suggested that the need of sternotomy is defined as more likely to be performed as follows: (1) RG with >70% of the mass extending in the mediastinum [25], (2) goiters > 10 cm, history of previous thyroidectomy, presence of invasive carcinoma and ectopic goiter [26], (3) extension to or below the aortic arch [27], (4) presence of malignancy, localization of the posterior mediastinum, extension below the aortic arch, presence of ectopic goiter [28], (5) extension to or below the tracheae carina, increased weight of the thyroid [18].…”

Section: Discussionmentioning

confidence: 99%

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

Sarı

Erbil

Ersöz

et al. 2012

Journal of Surgical Research

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“…23 patients (54.7%) showed with a significant symptomatology while 19 cases (45.3%) were asymptomatic and was accidently discovered. The mean neoplasms size was 9.97 cm in the benign group & 11.1 cm for the malignant group [18]- [20].…”

Section: Discussionmentioning

confidence: 92%

Surgical Approaches to Retrosternal Goiter, When Sternotomy Is Mandatory? National Cancer Institute Experience (NCI), Cairo University, Egypt

Fathalla¹,

Ahmed²

2016

JCT

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Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural injury. No other effective therapeutic alternative to surgery exists. Cervicotomy is still the surgical approach of choice, although a form of sternotomy may always be necessary for field extension and safe gland delivery. Materials and Methods: This is a single institution combined retrospective & prospective study including retrospective analysis of all cases presenting to the NCI, Cairo University with RG candidate for surgery between Jan. 2008 until the end of Dec. 2012, and a prospective study of all cases with the same presentation presenting to the NCI between Jan. 2013 until the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the clinico-pathological characteristics, the presentation, workup, surgical approaches and postoperative complications of RG. Results: 42 patients were included & were divided into benign (34 patients, 80.9%) and malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19 to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration of symptomatology was 23 months ranging (6-53 months). 23 patients (54.7%) were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients (73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy & 4 cases (9.5%) received postoperative radioactive iodine. No perioperative mortality occurred & the overall morbidity was 6 cases (14.2%) in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The median follow up period was 17.5 months. The median overall survival (OS) was 39.4 months and A. El Sayed Fathalla, B. El Din Ahmed 312 the median disease free survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy is a safe favorable approach to remove a RG. Intraoperative field extension up to a form of sternotomy may be necessary for gland delivery with increasing operating time, hospital stay and morbidity. Postoperative morbidity is mainly due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism which is mainly increased when sternotomy is performed.

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Sternotomy for substernal goitre: an otolaryngologist's perspective

Cited by 26 publications

References 11 publications

Substernal Goiter: When is a Sternotomy Required?

Substernal Goiter: When is a Sternotomy Required?

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

Surgical Approaches to Retrosternal Goiter, When Sternotomy Is Mandatory? National Cancer Institute Experience (NCI), Cairo University, Egypt

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