Surgery of retrosternal thyroid: evaluation of 82 cases

Retrosternal goiter (RSG) remains one of the most challenging conditions in thyroid surgery because of its variable mediastinal extension, close relationship with vital mediastinal structures, and occasional need for extracervical surgical approaches. Although advances in perioperative management have improved surgical outcomes, contemporary long-term single-center experiences remain limited. This study aimed to evaluate the clinical characteristics, surgical management, postoperative outcomes, and histopathological findings of patients with retrosternal goiter treated over a 13-year period at a tertiary referral center.

A retrospective cohort study was performed including consecutive patients who underwent surgery for retrosternal goiter at Erciyes University Faculty of Medicine between January 2012 and June 2025. Demographic characteristics, presenting symptoms, thyroid function, operative procedures, postoperative complications, and histopathological findings were retrospectively reviewed.

A total of 82 patients were included. The mean age was 55.0 ± 13.0 years, and 59.8% were female. Cervical swelling was the most common presenting symptom, while nearly one-third of patients were diagnosed incidentally. 91% of patients were euthyroid preoperatively. Total thyroidectomy was the predominant surgical procedure. A transcervical approach was sufficient in 80 patients (97.6%); one patient required partial sternotomy for deep anterior mediastinal extension with fibrous adhesions to the brachiocephalic vessels, and one underwent thoracotomy for posterior retroesophageal extension with subcarinal involvement. Temporary hypocalcemia was the most frequent postoperative complication, whereas permanent hypocalcemia and permanent recurrent laryngeal nerve palsy occurred in 3.7% and 1.2% of patients, respectively. No postoperative hematoma requiring reoperation, tracheomalacia, or perioperative mortality occurred. Benign multinodular or nodular colloid goiter was identified in 79.3% of patients, whereas follicular adenomas and other benign lesions accounted for 10.9%, and malignant lesions comprised 9.8% of the cohort.

In experienced hands, over 97% of retrosternal goiters can be successfully resected via a transcervical approach. Extracervical procedures are reserved for deep posterior retroesophageal extension or extensive mediastinal involvement below the aortic arch. Comprehensive preoperative CT planning and multidisciplinary care in high-volume tertiary referral centers ensure minimal morbidity.