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preLekára.sk / Journals / Perspectives in Surgery / 2020 - 11

Retrosternal goiter

Česká verzia

Authors: M. Švorcová;  P. Libánský;  M. Fialová;  S. Adámek;  R. Lischke
Authors place of work: III. chirurgická klinika 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Motol, Praha
Published in the journal: Rozhl. Chir., 2020, roč. 99, č. 11, s. 492-496.
Category: Original articles

Summary

Introduction: Retrosternal goiter is an enlarged thyroid mass of which more than 50% is located in the mediastinum. Indications for surgery of retrosternal goiter include ineffective pharmacological treatment, mechanical syndrome, suspicion of malignancy and thyrotoxicosis. Computed tomography is the gold standard in the diagnosis of retrosternal goiter. The surgery can be performed from a cervical incision, using sternotomy or thoracotomy.

Methods: The aim of our study was to evaluate our own group of retrosternal goiters. In 2011–2019, 1739 thyroid surgeries were performed at the 3rd Department of Surgery, University Hospital Motol, Prague. We retrospectively followed the age, gender, retrosternal spreading, postoperative complications (especially hypocalcemia, bleeding and dysphonia) and the definitive histological finding.

Results: Retrosternal goiters were presented in 202 (19.2%) of the total of 1739 thyroid surgery patients. Sternotomy was performed in 31 patients. Women (61%) predominated over men (39%). The mean operating time was 125 minutes. We did not detect any serious postoperative bleeding necessitating surgical revision. Temporary hypocalcemia was observed in 10 patients (32%) based on laboratory testing. Unilateral iatrogenic vocal cord paresis was observed in 6 patients (19.4%) and was permanent in 3 patients (9.3%). One patient passed away soon after the operation, nevertheless the death was related to a simultaneously planned cardiothoracic procedure.

Conclusion: The retrosternal goiter can be removed using the cervical approach in most cases. Total thyroidectomy using sternotomy is associated with higher morbidity and mortality, higher blood loss and longer hospital stay; nevertheless, it does not increase the risk of long-term postoperative complications. Procedures requiring sternotomy or thoracotomy should be done at centers experienced in these types of procedures.

Keywords:

retrosternal goiter – sternotomy – thoracotomy − thyroid gland disease − vocal cord paresis

Zdroje
  1. Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg. 1998;14(4):393−397. doi:10.1016/s1010-7940(98)00204-8.
  2. Chow TL, Chan TT, Suen DT, et al. Surgical management of substernal goitre: local experience. Hong Kong Med J. 2005;11(5):360−365.
  3. Newman E, Shaha AR. Substernal goiter. J Surg Oncol. 1995;60(3):207−212. doi:10.1002/jso.2930600313.
  4. Batori M, Chatelou E, Straniero A. Surgical treatment of retrosternal goiter. Eur Rev Med Pharmacol Sci. 2007;11(4):265−268.
  5. Moron JC, Singer JA, Sardi A. Retrosternal goiter: a six-year institutional review. Am Surg. 1998 Sep;64(9):889−893.
  6. Eising EG, Rosenbaum-Krumme S, Jentzen W, et al. Definition of retrosternal thyroid growth. Open Journal of Clinical Diagnostics 2012;2:36−39.
  7. Ignjatović M, Stanić V, Cuk V, et al. Intrathoracic goiter: analysis of 21 cases. Acta Chir Iugosl. 2002;49(1):15−25. doi:10.2298/aci0201015i.
  8. Nakayama H, Goda M, Kohagura K, et al. A large substernal goiter that extended to both sides of the thorax. Case Rep Surg. 2018 [on-line]. doi: 10.1155/2018/6107982.
  9. Lin YS, Wu HY, Lee CW, et al. Surgical management of substernal goitres at a tertiary referral centre: A retrospective cohort study of 2,104 patients. Int J Surg. 2016;27:46−52. doi: 10.1016/j.ijsu.2016.01.032.
  10. Coskun A, Yildirim M, Erkan N. Substernal goiter: when is a sternotomy required? Int Surg. 2014;99(4):419−425. doi: 10.9738/INTSURG-D-14-00041.1.
  11. Hall TS, Caslowitz P, Popper C, et al. Substernal goiter versus intrathoracic aberrant thyroid: a critical difference. Ann Thorac Surg. 1988;46(6):684−685. doi:10.1016/s0003-4975(10)64734-0.
  12. Dvořák J. Štítná žláza, chirurgická anatomie, operační technika. Praha, Seziba 2000:258−275.
  13. Abboud B, Sleilaty G, Mallak N, et al. Morbidity and mortality of thyroidectomy for substernal goiter. Head Neck. 2010;32(6):744−749. doi: 10.1002/hed.21246.
  14. Shaha AR. Surgery for benign thyroid disease causing tracheoesophageal compression. Otolaryngol Clin North Am. 1990;23(3):391−401.
  15. Ahmed ME, Ahmed EO, Mahadi SI. Retrosternal goiter: the need for median sternotomy. World J Surg. 2006;30(11):1945−1948. doi:10.1007/s00268-006-0011-y.
  16. Bartsch DK, Luster M, Buhr HJ, et al. German Society for General and Visceral Surgery. Indications for the surgical management of benign goiter in adults. Dtsch Arztebl Int. 2018;115(1−02):1−7. doi:10.3238/arztebl.2018.0001.
  17. Abdullah AS, Bahjat AS, Mohammed AA. Huge toxic goiter extending to the posterior mediastinum; case report with literature review. Int J Surg Case Rep.2019;62:69−72. doi: 10.1016/j.ijscr.2019.08.016.
  18. Perincek G, Avci S, Celtikci P. Retrosternal goiter: A couple of classification methods with computed tomograpy findings. Pak J Med Sci. 2018;34(6):1494−1497. doi: 10.12669/pjms.346.15932.
  19. Mercante G, Battaglia P, Manciocco V, et al. Three-dimensional minimally invasive video-assisted thyroidectomy: preliminary report. J Exp Clin Cancer Res. 2013;32:78. doi: 10.1186/1756-9966-32-78.
  20. Mercante G, Gabrielli E, Pedroni C, et al. CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach. Head Neck. 2011;33(6):792−799. doi: 10.1002/hed.21539.
  21. Hardy RG, Bliss RD, Lennard TW, et al. Management of retrosternal goitres. Ann R Coll Surg Engl. 2009;91(1):8−11. doi: 10.1308/003588409X359196.
  22. Sakkary MA, Abdelrahman AM, Mostafa AM, et al. Retrosternal goiter: The need for thoracic approach based on CT findings: surgeon‘s view. J Egypt Natl Canc Inst. 2012;24(2):85−90. doi: 10.1016/j.jnci.2012.04.002.
  23. Huins CT, Georgalas C, Mehrzad H, et al. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008 Feb;6(1):71−76. doi:10.1016/j.ijsu.2007.02.003.
  24. Nankee L, Chen H, Schneider DF, et al. Substernal goiter: when is a sternotomy required? J Surg Res. 2015;199(1):121−125. doi: 10.1016/j.jss.2015.04.045.
  25. White ML, Doherty GM, Gauger PG. Evidence-based surgical management of substernal goiter. World J Surg. 2008;32(7):1285−1300. doi:10.1007/s00268-008-9466-3.
  26. Di Crescenzo V, Vitale M, Valvano L, et al. Surgical management of cervico-mediastinal goiters: Our experience and review of the literature. Int J Surg. 2016;28 Suppl1:S47−53. doi: 10.1016/j.ijsu.2015.12.048.
  27. Qureishi A, Garas G, Tolley N, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg. 2013;11(3):203−208. doi: 10.1016/j.ijsu.2013.01.006.
  28. Cichoń S, Anielski R, Konturek A, et al. Surgical management of mediastinal goiter: risk factors for sternotomy. Langenbecks Arch Surg. 2008;393(5):751−757. doi: 10.1007/s00423-008-0338-y.
  29. Casella C, Pata G, Cappelli C, et al. Preoperative predictors of sternotomy need in mediastinal goiter management. Head Neck. 2010;32(9):1131−1135. doi: 10.1002/hed.21303.
  30. Hallgrimsson P, Lovén L, Westerdahl J, et al. Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial. Langenbecks Arch Surg. 2008;393(5):675−680. doi: 10.1007/s00423-008-0361.
  31. Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28(3):271−276. doi:10.1007/s00268-003-6903-1.
  32. Janík J, Malý V, Lazanská V, et al. Intratorakální struma – nediagnostikovaná − přece odoperovaná. Rozhl Chir. 2010;89(11):663−665.
  33. Dvořák J. Štítná žláza, chirurgická anatomie, operační technika. Praha, Serofa 2000.
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Perspectives in Surgery

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