Abstract
The heterogeneity of retrosternal goiter size, nearby anatomical structures, and evolving surgical techniques translates to difficulty in selecting the most appropriate surgical approach. Decades of experience in the surgical treatment of retrosternal goiters at the London Health Sciences Centre has aided in the development of a management algorithm to guide the decision-making process. Although most retrosternal goiters can be removed transcervically, a small proportion of patients fulfill anatomical and radiological criteria for concurrent extracervical approaches. Anterior goiters above the level of the pericardium were resected using cervical thyroidectomy with either mediastinoscopic-assisted delivery or cervical thyroidectomy with video-assisted thyroidectomy (VATS). Anterior goiters extending beyond the pericardium require median sternotomy to facilitate sufficient vascular control and exposure. Posteriorly extending goiters can be managed using trans-thoracic approaches including lateral thoracotomy or VATS.
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References
White ML, Doherty GM, Gauger PG (2008) Evidence-based surgical management of substernal goiter. World J Surg 32(7):1285–1300
Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73(9):761–768
Page C, Strunski V (2007) Cervicothoracic goitre: an anatomical or radiological definition? Report of 223 surgical cases. J Laryngol Otol 121(11):1083–1087
Huins CT, Georgalas C, Mehrzad H, Tolley NS (2008) A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg 6(1):71–76
Randolph GW, Shin JJ, Grillo HC et al (2011) The surgical management of goiter: Part II. Surgical treatment and results. Laryngoscope 121(1):68–76
Wang X, Zhou Y, Li C et al (2020) Surgery for retrosternal goiter: cervical approach. Gland Surg 9(2):392–400
Coskun A, Yildirim M, Erkan N (2014) Substernal goiter: when is a sternotomy required? Int Surg 99(4):419–425
Sakkary M, Abdelrahman A, Mosatafa A, Abbas A, Zedan M (2012) Retrosternal goiter: The need for thoracic approach based on CT findings: surgeon’s view. J Egypt Natl Canc Inst 24:85–90
Cohen JP (2009) Substernal goiters and sternotomy. Laryngoscope 119(4):683–688
Whitson BA, Andrade RS, Boettcher A et al (2007) Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 83(6):1965–1970
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This is a purely descriptive study outlining the approaches to the management of retrosternal goiter using several case examples. All information was de-identified, and, hence, ethics board review was not sought.
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Petrides, G.A., Inculet, R., Fung, K. et al. A Surgical Algorithm for the Management of Retrosternal Goiters. Indian J Surg (2023). https://doi.org/10.1007/s12262-023-03946-2
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DOI: https://doi.org/10.1007/s12262-023-03946-2