Should asymptomatic retrosternal goitre be left untreated? A prospective single-centre study

Area of Science:

• Surgical Oncology
• Endocrinology
• Thoracic Surgery

Background:

• Retrosternal goiters can cause airway obstruction and dysphagia, but are often asymptomatic and incidentally found.
• While sternotomy is usually unnecessary, surgery for retrosternal goiters has higher complication rates than cervical goiters.
• There is ongoing debate regarding surgical intervention for asymptomatic retrosternal goiters due to potential risks and benefits.

Purpose of the Study:

• To evaluate the risks and outcomes of surgery for benign retrosternal goiters.
• To compare complication rates between symptomatic and asymptomatic patients.
• To determine the incidence of unsuspected thyroid cancer in surgically resected retrosternal goiters.

Main Methods:

• A retrospective review of 132 patients who underwent surgery for benign retrosternal goiter between 1984 and 2012.
• Preoperative assessment included clinical evaluation and fine needle cytology to confirm benignity.
• Surgical approach (sternotomy vs. collar incision) and postoperative outcomes were analyzed.

Main Results:

• Sternotomy was required in only 4% of cases; 3 patients (2.3%) experienced postoperative mortality.
• Morbidity and mortality rates were similar for patients with (16.7%) and without (13.9%) compression symptoms.
• Histological examination revealed no cases of unsuspected thyroid cancer.

Conclusions:

• Surgery for retrosternal goiters presents a higher risk of complications compared to cervical goiters, with no significant difference between symptomatic and asymptomatic patients.
• The absence of unsuspected cancer in this series challenges the routine surgical indication for asymptomatic retrosternal goiters without suspicious findings.
• These findings suggest a need to reconsider the management strategy for asymptomatic retrosternal goiters, emphasizing individualized risk-benefit assessment.