Andrea Polistena1, Alessandro Sanguinetti2, Roberta Lucchini3, Sergio Galasse4, Massimo Monacelli5, Stefano Avenia6, Roberta Triola7, Walter Bugiantella8, Fabio Rondelli9, Roberto Cirocchi10, Nicola Avenia11. 1. Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: apolis74@yahoo.it. 2. Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: alessandrosanguinetti@gmail.com. 3. Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: robertalucchini@alice.it. 4. Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: sergio.galasse@gmail.com. 5. Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: massimo.monacelli@gmail.com. 6. Medical School, University of Perugia, Italy. Electronic address: stefano_avenia@libero.it. 7. Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: triolaroberta@gmail.com. 8. Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: walterbugiantella@alice.it. 9. Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: rondellif@hotmail.com. 10. Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: roberto.cirocchi@unipg.it. 11. Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: nicolaavenia@libero.it.
Abstract
AIM: Surgery for mediastinal goiters (MG) is indicated for compression symptoms and risk of malignancy. Total thyroidectomy by cervicotomy is universally considered the standard surgical approach to MG. In selected cases sternotomy or a thoracotomy are used. Options of the operative technique and practical surgical problems are analysed. METHODS: A retrospective analysis of twenty-eight-years on 1767 cases of MG in a referral centre for endocrine surgery was carried out. All patients underwent standard preoperative study and CT based surgical planning. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected case via sternotomy or thoracotomy. Clinical records were examined. RESULTS: Total thyroidectomy was performed in all cases. A cervical approach was used in almost 99% of patients. Significant shorter surgical time was observed for surgery via the cervical approach vs sternotomy and thoracotomy. Benign struma was observed in 1503 patients and a carcinoma in 264. We observed postoperative bleeding in 0.5% of cases, permanent monolateral recurrent laryngeal nerve palsy occurred in 1.3%, bilateral palsy in 0.6%, transient and permanent hypoparathyroidism in 14% and 4.1% respectively. CONCLUSION: MG may be approached by a cervicotomic access only with a clear knowledge of potential risk and complications of the surgical manoeuvres. Sternotomy or of a thoracotomy are indicated only in selected cases but their inapplicability may be really dangerous in those MG not otherwise resectable. MG should be referred only to specialized centre.
AIM: Surgery for mediastinal goiters (MG) is indicated for compression symptoms and risk of malignancy. Total thyroidectomy by cervicotomy is universally considered the standard surgical approach to MG. In selected cases sternotomy or a thoracotomy are used. Options of the operative technique and practical surgical problems are analysed. METHODS: A retrospective analysis of twenty-eight-years on 1767 cases of MG in a referral centre for endocrine surgery was carried out. All patients underwent standard preoperative study and CT based surgical planning. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected case via sternotomy or thoracotomy. Clinical records were examined. RESULTS: Total thyroidectomy was performed in all cases. A cervical approach was used in almost 99% of patients. Significant shorter surgical time was observed for surgery via the cervical approach vs sternotomy and thoracotomy. Benign struma was observed in 1503 patients and a carcinoma in 264. We observed postoperative bleeding in 0.5% of cases, permanent monolateral recurrent laryngeal nerve palsy occurred in 1.3%, bilateral palsy in 0.6%, transient and permanent hypoparathyroidism in 14% and 4.1% respectively. CONCLUSION:MG may be approached by a cervicotomic access only with a clear knowledge of potential risk and complications of the surgical manoeuvres. Sternotomy or of a thoracotomy are indicated only in selected cases but their inapplicability may be really dangerous in those MG not otherwise resectable. MG should be referred only to specialized centre.