Surgical management of mediastinal goiter: risk factors for sternotomy

Cichoń, S; Anielski, Ryszard; Konturek, Aleksander; Baczyński, Marcin; Cichoń, Wojciech; Orlicki, Paweł

doi:10.1007/s00423-008-0338-y

Cited by 45 publications

(55 citation statements)

References 17 publications

(33 reference statements)

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“…Furthermore, attempts to establish any significant correlation between the patients' clinical features and the actual surgical procedure always proved fruitless. [10][11][12][13][14] In the present study, we found that extension of the goiter below the level of the aortic arch appeared to be a significant predictive factor for the need for sternotomy, displaying an OR of almost 33. Conversely, the lack of radiologic extension beyond the aortic arch predicted successful transcervical removal of mediastinal goiters without sternotomy.…”

Section: Discussionsupporting

confidence: 49%

“…In this study, we defined mediastinal goiters as only goiters extending below the thoracic inlet by at least 3 cm at CT scan evaluation with the neck in hyperextension, as this is 1 of the most widely accepted definitions. 10,17,18 Nevertheless, studies including only goiters reaching or descending below the aortic arch, 12 or having >50% of the mass located below the thoracic inlet, 19 or even with any extent of the gland below the thoracic inlet have also been published. 20,21 If we had used less selective inclusion criteria and comprised goiters with any part of the gland extending below the thoracic inlet (378 thyroids in the same study period), then the duration of mediastinal goiter's history would have not resulted as a risk factor for sternotomy (OR 2.78; 95% CI 0.95-8.16; p ¼ .07), whereas its extension below the level of the aortic arch would have been an even stronger predictor of sternal incision at operation (OR ¼ 34; 95% CI, 11-104; p < .0001).…”

Section: Discussionmentioning

confidence: 99%

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Preoperative predictors of sternotomy need in mediastinal goiter management

et al. 2010

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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

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Preoperative predictors of sternotomy need in mediastinal goiter management

et al. 2010

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“…Sternotomy is performed in about 0-11% of cases. This wide range may be explained by the lack of a common SG definition (2,5,6,(11)(12)(13). In this study, sternotomy or thoracotomy were not applied, all patients were operated through cervical approach.…”

Section: Discussionmentioning

confidence: 99%

“…Sternotomy is performed in about 0 to 11% cases. This wide range may be explained by the absence of a common SG definition (6,7,(10)(11)(12)(13). Most of the SG studies have been published as series of author's self-experience, evaluation of their own surgical techniques and comparison of other studies on SG.…”

Section: Introductionmentioning

confidence: 99%

Cervical Approach to Substernal Goiter: Do we Need Sternotomy? Cerrahpaşa Experience

Teksöz¹,

Bükey²,

Ulusan³

et al. 2013

Tjem

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Abs tractPurpose: The purpose of this study was to evaluate the clinical and surgical differences between substernal goiter and non substernal goiter according to institutional experience. Material and Method:Twenty-nine patients with substernal goiter and 62 randomly chosen non substernal goiter patients from January 2009 to October 2012 were compared retrospectively according to their pre-operative and post-operative data. Cervical approached total thyroidectomy was applied to patients with substernal goiter. Results:Thirteen of twenty-nine substernal goiter patients were male (44.8%) and 16 were female (55.2%). Body mass index, age, gender in both groups were compared and found to be similar. No post-operative complication was observed. Pathology results revealed malignancy in 24.1% of patients. Discussion:Patients with substernal goiter can be safely treated through the cervical approach with low complication rates in expert hands. Turk Jem 2013; 17: 116-20

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“…Success rates of greater than 99% have been reported using the cervical approach, [12] while other studies have shown that up to 30% of patients require thoracic intervention. [13] Again, the incidence of extra-cervical approach being required is affected greatly by which definition of retrosternal goitre is used. Most studies state an incidence of around 10% or lower.…”

Section: Introductionmentioning

confidence: 99%

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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Surgical management of mediastinal goiter: risk factors for sternotomy

Cited by 45 publications

References 17 publications

Preoperative predictors of sternotomy need in mediastinal goiter management

Preoperative predictors of sternotomy need in mediastinal goiter management

Cervical Approach to Substernal Goiter: Do we Need Sternotomy? Cerrahpaşa Experience

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

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