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Updated: Jun 22, 2026

Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
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Transcervical elective superior mediastinal dissection for thyroid carcinoma.

Yadranko Ducic1, Lance Oxford

  • 1Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center Dallas, TX, USA. yducic@sbcglobal.net

American Journal of Otolaryngology
|July 1, 2009
PubMed
Summary

Elective superior mediastinal dissection for thyroid cancer frequently found disease, especially in papillary, medullary, and anaplastic types. This transcervical approach is safe, but its survival impact requires further study.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Head and Neck Surgery

Background:

  • Thyroid carcinoma management often involves lymph node assessment.
  • Superior mediastinal lymph node metastasis is a concern in certain thyroid cancer subtypes.
  • The efficacy and safety of elective superior mediastinal dissection (SMD) are debated.

Purpose of the Study:

  • To evaluate the outcomes of elective superior mediastinal dissections in patients with thyroid carcinoma.
  • To determine the incidence of superior mediastinal metastasis in various thyroid cancer types.
  • To assess the safety and feasibility of a transcervical approach for SMD.

Main Methods:

  • Retrospective review of operative case logs over a 6-year period.
  • Inclusion criteria: thyroid carcinoma treated with elective SMD by the senior author.

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  • Indications for SMD: positive frozen section, tumor fixation, palpable adenopathy, or tumor size >2.0 cm.

    • Main Results:

    • Thirty-one patients underwent elective SMD; 19 (61.3%) had positive superior mediastinal disease.
    • Positive nodes were found in 65% of papillary, 80% of medullary, and 100% of anaplastic thyroid carcinomas.
    • Follicular thyroid carcinoma showed a significantly lower incidence of mediastinal disease (0%) compared to non-follicular types (70.4%).
    • Cervical metastasis correlated with a higher incidence of superior mediastinal disease (100% vs 53.3%).

    Conclusions:

    • Elective transcervical SMD is frequently positive for papillary, medullary, and anaplastic thyroid carcinomas.
    • The transcervical approach can be safely performed to the level of the brachiocephalic vein without sternotomy.
    • Further research is needed to ascertain the impact of elective SMD on patient survival.