[Specific morbidity of substernal goiters. A comparative study with a matched series of cervical goiters]

The operative morbidity rates in patients operated for substernal goiter (SG) vary from one series to another. The aim of this study was to reevaluate the morbidity using a matched technique. Each SG was matched to a cervical goiter for surgical technique, histology and thyroid function. There were 97 SG (75% of women), 43% with normal thyroid function, 28% with mild hyperthyroidism, 29% with hyperthyroidism. 87% of thyroidectomies were bilateral. Mean age was 66.5 +/- 11.5 years versus 55.8 +/- 11.9 years for cervical goiters (p < 0.001). The percentage of men was higher for SG than for cervical goiter (25% versus 10%, p < 0.01). Specimen weighed 166 +/- 109g versus 76 +/- 95g (p < 0.0001). Total volume of drainage was 164.0 +/- 68 ml versus 123.2 +/- 68 ml (p = 0.003). No operative death occurred. Early hypoparathyroidism rate was 3% versus 2% (p = 0.5), and late hypoparathyroidism was 1% versus 0% (p = 0.5). There was a 10 mg/l in serum calcium post-operative drop in both groups but no change in serum phosphate was noted (bilateral thyroidectomies). The early recurrent laryngeal nerve palsy rate was 4% versus 0% (p = 0.06) and 3% versus 0% one year later (p = 0.12). Early postoperative reoperation rate for hemostasis was 2% versus 1% respectively (p = 0.25). We conclude that there is no significant difference in surgical morbidity between thyroidectomies for SG and cervical goiters when patients are operated in specialized centers. Operative fears are not justified.