Is Cervicotomy Enough for Removal of Retrosternal Goiters?

Abstract

Aim: The aim of this study was to evaluate the surgical approaches in retrosternal goiters. Materials and Methods: We reviewed 23 patients operated with the diagnosis of retrosternal goiter. Twelve (52%) of the cases were female and 11 (48%) were male. Mean age was 53.8 +/- 10.9 years. Shortness of breath was seen in 12 (52%) of the patients as the most frequent preoperative symptom. On the chest posteroanterior radiography, 18 (78%) cases were found to have tracheal compression. CT images demonstrated retrosternal extension to the level of the aortic arch in all patients. All 23 patients were prepared for a thoracic approach. Results: Among 448 cases operated with the diagnosis of goiter. 23 patients (5.1%) had evidence of retrosternal goiter. Of those 23 patients, only 10 had deep retrosternal extension of the goiter that actually required a thoracic approach. which accounted for 2.2% of all thyroidectomies performed. Total median sternotomy in seven cases, partial sternotomy in two cases and right thoracotomy in one case were performed. Hypoparathyroidism was not detected postoperatively and no hospital mortality occurred. Conclusions: Goiters extending to the mediastinum can be excised successfully by cervical incision. Thoracic approach has an excellent outcome, achieving a safe resection and relieving all symptoms, especially in large or recurrent goiters extending to the mediastinum and with close relation to mediastinal structures.