The value of various definitions of intrathoracic goiter for predicting intra-operative and postoperative complications

Rı́os, Antonio; Rodrı́guez, José Manuel; Balsalobre, María; Tébar, Francisco Javier; Parrilla, Pascual

doi:10.1016/j.surg.2009.06.018

Cited by 66 publications

(56 citation statements)

References 24 publications

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“…The 'clinical definition': 'a thyroid gland that on neck examination without being in hyperextension, has a portion that remains permanently retrosternal,' is the most inclusive definition, and is sensitive for determining presence of compressive symptoms and predicting difficult intubation. [8] Katlic's definition: >50% of volume intrathoracic, is the most sensitive for predicting sternotomy, and an argument could be made that it is valuable to use this definition in certain research. [8] Use of other definitions is unlikely to be necessary and should be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…[8] Katlic's definition: >50% of volume intrathoracic, is the most sensitive for predicting sternotomy, and an argument could be made that it is valuable to use this definition in certain research. [8] Use of other definitions is unlikely to be necessary and should be avoided. Some of the disagreement in the literature could also be down to surgical technique, experience, and attitude, as some surgeons are more reluctant or willing to use sternotomy.…”

Section: Discussionmentioning

confidence: 99%

“…[26] Ríos et al 2010, claim that this is the best definition for predicting sternotomy. [8] Further analysis of data was performed using only those patients who met Katlic's definition of retrosternal goitre. Many patients in the cervical group had very small intrathoracic volume.…”

Section: The Star On the Boxplot Of Volumetric Indexes For The Cervicmentioning

confidence: 99%

“…The incidence of retrosternal goitre varies substantially across the literature, mainly due to these differences in definition. [8] One study showed that the incidence of retrosternal goitre in their group of patients could vary from 2.8% to 48%, if using the most and least restrictive definitions respectively. [8] Retrosternal goitres can be classified as primary or secondary.…”

Section: Introductionmentioning

confidence: 99%

“…[8] One study showed that the incidence of retrosternal goitre in their group of patients could vary from 2.8% to 48%, if using the most and least restrictive definitions respectively. [8] Retrosternal goitres can be classified as primary or secondary. Secondary retrosternal goitres are those which extend inferiorly from the original position in the neck.…”

Section: Introductionmentioning

confidence: 99%

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Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy

Evans¹,

Shafi²,

Singh³

et al. 2017

ASS

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Surgical removal is the recommended treatment for retrosternal goitre. This can be successfully achieved through a cervical incision in most cases, however occasionally a thoracic approach is required. Being able to predict the need for sternotomy would improve logistical efficiency, saving time and money, and allow patients to be better informed preoperatively. The aim of this study was to determine whether analysing thyroid volume on preoperative CT scans could help predict the use of sternotomy. To the best of our knowledge this is the first study investigating this. A retrospective study was conducted on 64 patients who underwent thyroidectomy for retrosternal goitre at the Golden Jubilee National Hospital, Scotland, between 2012-2016. Patient demographic information and pathological reports were obtained from databases. Preoperative CT scans were used for volumetric analysis. The total volume, the volume inferior to the level of the sternal notch (intrathoracic volume), and the anteroposterior diameter of the thoracic inlet were measured. An index of relative goitre size was calculated by dividing intrathoracic volume by thoracic inlet diameter. Mann-Whitney U tests and Fisher's exact tests were used to analyse continuous and categorical variables respectively. Goitres were successfully removed by a cervical incision alone in 55 patients, while thoracic intervention was needed in 9 cases (13.3%). Intrathoracic volume (p=0.0091) and volumetric index (p=0.0033) were significantly larger in those requiring sternotomy. Total volume was not significantly different. All other variables measured were similar in both groups. Our results suggest that assessing intrathoracic volume of goitre is useful in predicting the need for sternotomy. However, it is not able to completely rule out thoracic intervention. The volumetric index is likely to be a better predictor than volume alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: The Star On the Boxplot Of Volumetric Indexes For The Cervicmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy

Evans¹,

Shafi²,

Singh³

et al. 2017

ASS

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Positional Dyspnea and Tracheal Compression as Indications for Goiter Resection

Stang¹,

Armstrong²,

Ogilvie³

et al. 2012

Arch Surg

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Hypotheses: Goiter is a surgically reversible cause of positional dyspnea (PD). Substernal tracheal compression (TC) predicts PD relief after thyroidectomy (Tx). Design: Retrospective analysis of a prospective structured management algorithm. Setting: Endocrine surgery academic center. Methods: Before Tx, 1081 patients were queried about PD. Those patients with substernal goiter underwent computed tomography, and their degree of TC was estimated as greatest percent reduction of transverse tracheal diameter. For 197 patients with PD, TC, or both, surgical outcomes were examined with a mean follow-up of 12.6 months. After Tx, patients who carried the diagnosis of obstructive sleep apnea were referred for repeat sleep study evaluation. Results: Positional dyspnea was reported by 188 of 1081 patients, and after Tx the PD improved or resolved in 82.4%. In the 151 patients with substernal goiter, TC was present on imaging in 97.2%; the mean (range) TC was 34% (5%-90%). Patients with TC had a high likelihood of PD (93.5%). After substernal goiter resection, PD improved in stepwise association with total resected thyroid gland weight. Improvement in PD was strongly predicted by both gland weight of 100 g or more (PϽ.001) and by TC of 35% or more (P Ͻ.01). After Tx, 59 of 77 snorers (76.6%) reported improvement in snoring, 77.1% of patients with obstructive sleep apnea reported improved PD, and 2 of 3 retested patients with obstructive sleep apnea demonstrated objective improvement in sleep study apnea-hypopnea index. Conclusions: Resection of bulky goiter frequently improves PD, which in substernal goiter is highly associated with TC. Either PD or TC of 35% or more prompt Tx. Goiter should be considered when obstructive sleep apnea is diagnosed.

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The Rare Ones: Horner's Syndrome, Complications from Surgical Positioning and Post‐Sternotomy Complications

Kus

Freeman

2012

Thyroid Surgery

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The value of various definitions of intrathoracic goiter for predicting intra-operative and postoperative complications

Cited by 66 publications

References 24 publications

Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy

Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy

Positional Dyspnea and Tracheal Compression as Indications for Goiter Resection

The Rare Ones: Horner's Syndrome, Complications from Surgical Positioning and Post‐Sternotomy Complications

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