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Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
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Substernal goiter: when is a sternotomy required?

Luke Nankee1, Herbert Chen1, David F Schneider1

  • 1Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin; Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin.

The Journal of Surgical Research
|May 16, 2015
PubMed
Summary
This summary is machine-generated.

Sternotomy for substernal goiters (SSG) is a rare surgical approach, typically only needed when the goiter extends below the aortic arch. Patients requiring sternotomy experienced longer surgeries and hospital stays compared to cervical approaches.

Keywords:
SternotomySubsternal goiterThyroidectomy

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Area of Science:

  • Surgical Oncology
  • Endocrinology
  • Thoracic Surgery

Background:

  • Substernal goiters (SSG) removal via sternotomy carries higher morbidity than cervical thyroidectomy.
  • Identifying predictors for sternotomy in SSG cases is crucial for surgical planning.
  • Analysis of SSG patient characteristics compared to cervical goiter patients was performed.

Purpose of the Study:

  • To identify predictors for sternotomy in substernal goiter (SSG) removal.
  • To analyze preoperative and postoperative characteristics of patients undergoing sternotomy for SSG.
  • To compare SSG patients requiring sternotomy with those treated via cervical approach.

Main Methods:

  • Retrospective review of a surgical database from 1995-2013.
  • Inclusion criteria: large (>100g) thyroids or SSG.
  • Comparison between SSG and cervical goiter patients, focusing on sternotomy cases.

Main Results:

  • Of 220 patients, 127 (58%) had SSG, with 7 (5.5%) requiring sternotomy.
  • Sternotomy patients had goiter extension below the aortic arch, chest pressure, and voice complaints.
  • Sternotomy averaged 2 hours longer, with more blood loss (600 vs. 190 mL) and longer stay (3.1 vs. 1.8 days).

Conclusions:

  • Sternotomy for substernal goiters is infrequent.
  • Goiter extension below the aortic arch is a key indicator for sternotomy.
  • Preoperative symptoms like chest pressure and voice issues predict the need for sternotomy.