[Substernal goiter. Report of 212 cases]

Area of Science:

• Endocrinology
• Surgical Oncology
• Thoracic Surgery

Background:

• Substernal goiters, often diagnosed in women, can present significant surgical challenges due to their intrathoracic extension.
• Accurate preoperative evaluation of substernal goiter extension is crucial for surgical planning.

Purpose of the Study:

• To report the surgical treatment outcomes for a series of 210 patients with substernal goiters.
• To evaluate the efficacy and safety of a cervical approach for substernal goiter removal.

Main Methods:

• Retrospective analysis of 210 patients undergoing surgery for substernal goiters between 1982 and 1996.
• Surgical approach primarily via cervical incision (208 cases), with sternotomy in two cases.
• Detailed dissection techniques, including recurrent nerve identification and tracheal attachments, were employed.

Main Results:

• The cervical approach was successful in most cases, with 160 cases of easy extraction and 48 facilitated by specific dissection techniques.
• Transient laryngeal nerve palsy occurred in 7.2% and transient hypoparathyroidism in 13.4%.
• Definitive complications included laryngeal nerve palsy in 1.2% and persistent hypoparathyroidism in 2.1%.

Conclusions:

• CT scan and MRI are recommended for evaluating intrathoracic substernal goiters.
• A complete cervical dissection, with recurrent nerve identification, facilitates substernal goiter removal, even for large goiters.
• The cervical approach is a safe and effective primary surgical strategy for substernal goiters.