Abstract
Background and aims
Mediastinal goiter constitutes an indication for surgical management. The procedure can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The objective of the investigation was to analyze the prevalence and therapeutic results in patients with mediastinal goiter and to assess factors that affect the need of performing sternotomy in the course of mediastinal goiter surgery.
Material and methods
In the years 1984–2004, i.e., over 21 years, 11,849 patients with various types of goiter were operated on in the department. Mediastinal goiter was detected in 88 (0.76%) individuals. The analyzed material included 64 (72.7%) females and 24 (27.3%) males. The age of the patients ranged between 19 to 81 years, with the mean age of 61 ± 13 years of life. The material was statistically analyzed. Risk factors for sternotomy were assessed using the multidimensional logistic regression method.
Results
The highest percentage of mediastinal goiter was noted in patients operated on due to recurrent goiter (3.86%). Goiter situated in the anterior mediastinum was noted in 61 (69.3%) individuals, while 27 (30.7%) patients demonstrated goiter located in the posterior mediastinum; of the latter, nine were previsceral and 18 retrovisceral. In the majority of cases, these were primarily cervical goiters, which descended from the neck to the mediastinum (53 patients). Aberrant adenomas were diagnosed in 32 (36.4%) individuals. Four patients presented with the superior cava vein syndrome. Primary goiters evaluated intraoperatively with blood supply originating from the mediastinal vessels were observed in 12 (13.6%) cases. In 27 (30.7%) patients, sternotomies were necessary. In the majority of cases, these were individuals with goiters showing additional blood supply originating from the mediastinal vessels, patients with aberrant adenomas in the mediastinum, especially in recurrent goiters, or else subjects with goiters situated in the posterior mediastinum as compared to anterior mediastinal goiters. No postoperative mortality during stay in a hospital was noted.
Conclusions
Surgical management of patients with mediastinal goiter is the therapeutic modality that requires considerable experience of the surgical team, performed in specialized centers, and appropriate preoperative diagnostic management. Statistically significant risk factors for sternotomy are as follows: recurrent goiter, primary mediastinal goiter, posterior mediastinal location of goiter, and the presence of an aberrant adenoma situated in the mediastinum.
This is a preview of subscription content, log in via an institution to check access.
References
Wheeler MH (1999) Retrosternal goiter. Br J Surg 86:1235–1236
Sancho JJ, Kramimps JL, Sanchez-Blanco JM, Larrad A, Rodriguez JM, Gil P, Gibelin H, Pereira JA, Sitges-Serra A (2006) Increased mortality and morbidity associated with thyroidectomy for intrathoracic goiters reaching the carina tracheae. Arch Surg 141:82–85
Sand ME, Laws HL, McElvein RB (1983) Substernal and intrathoracic goiter. Reconsideration of surgical approach. Am Surg 49(4):196–202
Gough I (2006) Invited commentary on retrosternal goiter: the need for median sternotomy. World J Surg 30:1949
De Andrade MA (1977) A review of 128 cases of posterior mediastinal goiter. World J Surg 1:789–794
Gamblin TC, Jennings GR, Christie DB III, Thompson WM Jr, Dalton ML (2003) Ectopic thyroid. Ann Thorac Surg 75:1952–1953
Newman E, Shaha AR (1995) Substemal goiter. J Surg Oncol 60:207–212
Erbil Y, Bozbora A, Barbaros U, Özarmag˘an S, Azezli A, Molvalilar S (2004) Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today 34:732–736
Hedayati N, McHenry CR, Prinz RA, DeJong SA (2002) The clinical presentation and operative management of nodular and diffuse substernal thyroid disease/discussion. Am Surgeon Atlanta 68(3):245–248
Makeieff M, Marlier F, Khudjadze M, Garrel R, Crampette L, Guerrier B (2000) Les goitres plongeants. À propos de 212 cas. Ann Chir 125:18–25
Moran JC, Singer JA, Sardi A (1998) Retrosternal goiter: a six-year institutional review. Am Surg 1(64):889–893
Rodriguez JM, Hernandez Q, Pinero A, Ortiz S (1999) Substernal goiter: clinical experience of 72 cases. Ann Otol Rhinol Laryngol 108(5):501–504
Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, Ughe M, Mattioli F (1995) Surgical management of substernal goiter: analysis of 237 patients. Am Surg 61:826–831
Veronesi G, Leo F, Solli PG, D’Aiuto M, D’Ovidio F, Mazzarol G, Spaggiari L, Pastorino U (2001) Life-threatening giant mediastinal goiter: a surgical challenge. J Cardiovascular Surg 42(3):429–430
Pemberton J (1921) Surgery of substernal and intrathoracic goiters. Arch Surg 2:1
Shen WT, Kebebew E, Duh QY, Clark OH (2004) Predictors of airway complications after thyroidectomy for substernal goiter. Arch Surg 139(6):656–660
Grainger J, Saravanappa N, D’Souza A, Wilcock D, Wilson PS (2005) The surgical approach teoretrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg 132:849–851
Shaha AR (2003) Difficult thyroid. Oper Tech Otolaryngol Head Neck Surg 14(2):103–105
Netterville JL, Coleman SC, Smith JC, Day TA, Burkey BB (1998) Management of substernal goiter. Laryngoscope 108(11):1611–1617
Houck WV, Kaplan AJ, Reed CE, Cole DJ (1998) Intrathoracic aberrant thyroid: identification critical for appropriate operative approach. Am Surg 64(4):360–362
Salter S, Williams JT (2001) The aberrant thyroid. Curr Surg 58(5):481–482
Ahmed ME, Ahmed EO, Mahadi SI (2006) Retrosternal goiter: the need for median sternotomy. World J Surg 30(11):1945–1948
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cichoń, S., Anielski, R., Konturek, A. et al. Surgical management of mediastinal goiter: risk factors for sternotomy. Langenbecks Arch Surg 393, 751–757 (2008). https://doi.org/10.1007/s00423-008-0338-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-008-0338-y