Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Surg Proced. Nov 28, 2013; 3(3): 37-40
Published online Nov 28, 2013. doi: 10.5412/wjsp.v3.i3.37
Treatment of cervico-mediastinal goiters
Prospero Magistrelli, Luigi D’Ambra, Pierfrancesco Bonfante, Elisa Francone, Rossella Leoncini, Mario Cappagli, Emilio Falco
Prospero Magistrelli, Luigi D’Ambra, Pierfrancesco Bonfante, Elisa Francone, Emilio Falco, Department of Surgery, S. Andrea Hospital, 19100, La Spezia, Italy
Rossella Leoncini, Mario Cappagli, Department of Nuclear Medicine, S. Andrea Hospital, 19100 La Spezia, Italy
Author contributions: All the authors made substantial contributions to the concept, design, acquisition and interpretation of data, reading and approving the final version of the manuscript.
Correspondence to: Luigi D’Ambra, MD, Department of Surgery, S. Andrea Hospital, Via Vittorio Veneto 197, 19100 La Spezia, Italy.
Telephone: +39-18-7533257 Fax: +39-18-7533465
Received: May 8, 2013
Revised: September 3, 2013
Accepted: November 1, 2013
Published online: November 28, 2013

AIM: To compare our ten year results for thyroidectomy for cervico-mediastinal goiters with the best surgical treatment reported in the literature.

METHODS: From January 2000 to December 2009, of 1530 patients who underwent thyroidectomy in our department, we selected 105 cases of cervico-mediastinal goiter. In the majority of cases, the cervical approach is the standard procedure and only occasionally sternotomy or thoracotomy is necessary. The indications for surgery are generally related to a progressive increase of the thyroid mass into the anterior mediastinum with compression and dislocation of the trachea or esophagus and the possibility of an unknown malignancy.

RESULTS: In 98 (93.3%) of our 105 patients, the standard surgical approach was anterior cervicotomy followed by total thyroidectomy. In three cases, total sternotomy was performed and in the remaining four patients, a partial split sternotomy was effective to remove the intrathoracic mass. Post-operative complications included transient recurrent laryngeal nerve palsy in 6 patients (5.7%) which only became permanent in 2 patients (1.9%). The transient hypoparathyroidism rate was 22% but 2 mo after surgery permanent hypoparathyroidism was confirmed in only 2% of our selected group. No patients required temporary tracheostomy following surgery related to a possible bilateral nerve palsy. Patients received a single prophylactic antibiotic dose preoperatively and wound infections were not significant. There was no mortality in our selected group and most patients showed a significant improvement of dyspnea and other correlated symptoms postoperatively.

CONCLUSION: The majority of cervico mediastinal goiters can be completely removed through a cervical incision. In selected cases, generally malignancies with local infiltration of mediastinal soft tissues and adhesions to large vessels, split sternotomy may be a safer approach to not increase morbidity.

Keywords: Goiter, Sternotomy, Thyroidectomy, Mediastinum, Thoracotomy

Core tip: The majority of cervico-mediastinal goiters can be completely removed through a cervical incision. Volume reduction by a vascular peduncle ligature can facilitate the extraction of big goiters, with the result that sternotomy or thoracotomy is seldom necessary. Care must be taken to avoid recurrent laryngeal nerve injuries.