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Substernal goiters.

M Batori1, E Chatelou, A Straniero

  • 1Department of Surgical Sciences and Applied Medical Technologies, La Sapienza University, Rome, Italy.

European Review for Medical and Pharmacological Sciences
|February 17, 2006
PubMed
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Substernal goiters can be effectively treated with Kocher collar neck incision, avoiding sternotomy. This approach resolves mediastinal compression symptoms and allows for early discharge, with neoplastic degeneration noted in 11.1% of cases.

Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Thoracic Surgery

Background:

  • Substernal goiter, or cervico-mediastinic goiter, is a thyroid formation extending into the superior thoracic strait.
  • Its prevalence varies widely, from 1.7% to 30% of all thyroid conditions.
  • Diagnosis relies on imaging techniques like chest X-rays.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of surgical management for substernal goiters.
  • To assess the incidence of neoplastic degeneration in substernal goiters treated surgically.

Main Methods:

  • A retrospective analysis of 332 surgically treated thyroid pathology patients between 1998 and 2003.
  • Focus on 45 patients (13.5%) with cervico-mediastinic goiter.
  • Surgical approaches included total thyroidectomy (71.1%), hemithyroidectomy (24.5%), and isthmus-lobectomy completion (4.4%).

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Main Results:

  • Anterior collar neck incision (Kocher) was universally employed, obviating the need for sternotomy or thoracotomy.
  • All patients experienced resolution of mediastinal compression symptoms.
  • Histological examination revealed neoplastic degeneration in 11.1% of cases (6.6% papillary carcinoma, 4.5% follicular carcinoma).

Conclusions:

  • Kocher collar neck incision is a safe and effective approach for substernal goiters, resolving symptoms without major complications.
  • Early discharge (fourth postoperative day) is achievable with appropriate levothyroxine management.
  • The incidence of malignancy in this cohort aligns with existing literature, emphasizing the importance of surgical evaluation.