Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study

Abstract

Objective Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy. Methods In a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500). Results An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy. Level of evidence IV

An accessory mediastinal thyroid: A case report

“… 1 In the presented patient, due to location, size, and contiguity to the large structured vascular of mediastinal and trachea, it was decided to perform surgery through right thoracotomy. 6 , 7…”

“…However, sternotomy or thoracotomy techniques are used in cases where the mass is bulky and has adhesion or proximity to vital organs 1 . In the presented patient, due to location, size, and contiguity to the large structured vascular of mediastinal and trachea, it was decided to perform surgery through right thoracotomy 6,7 …”

Accuracy and diagnostic performance of the Bethesda system for reporting thyroid cytopathology in a tertiary endocrine surgical referral center in Belgium

“…Part of the study cohort has already been described. 10,11 All patients provided written informed consent prior to the study. Demographics, FNA cytology, data on surgical and associated procedures, and the final histopathology report were collected.…”

“…Patients were excluded if no preoperative FNA was performed or if the Bethesda category was missing on the FNA cytology report (Figure 1). Part of the study cohort has already been described 10,11 . All patients provided written informed consent prior to the study.…”

Retrosternal Goitre: Anatomical Aspects and Technical Notes

“…All patients had a preoperative neck ultrasound (US) and chest X-ray. An additional diagnosis included neck/chest computed tomography (CT) or magnetic resonance imaging to determine the optimal surgical technique [ 8 , 9 , 10 ]. Furthermore, all patients were evaluated by an otolaryngologist by means of a laryngo-tracheoscopy.…”