Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients.

Abstract

PURPOSE:

To compare the outcome in patients with cervical goiters and cervicomediastinal goiters (CMGs) undergoing total thyroidectomy using the cervical or extracervical approach.

METHODS:

This was a retrospective study conducted at six academic departments of general surgery and one endocrine-surgical unit in Italy. The study population consisted of 19,662 patients undergoing total thyroidectomy between 1999 and 2008, of whom 18,607 had cervical goiter (group A) and 1055 had CMG treated using a cervical approach (group B, n = 986) or manubriotomy (group C, n = 69). The main parameters of interest were symptoms, gender, age, operative time, duration of drain, length of hospital stay, malignancy and outcome.

RESULTS:

A split-sternal approach was required in 6.5% of cases of CMG. Malignancy was significantly more frequent in group B (22.4%) and group C (36.2%) versus group A (10.4%; both P < .001), and in group C versus group B (P = .009). Overall morbidity was significantly higher in groups B + C (35%), B (34.4%) and C (53.5%) versus group A (23.7%; P < .001). Statistically significant increases for group B + C versus group A were observed for transient hypocalcemia, permanent hypocalcemia, transient recurrent laryngeal nerve (RLN) palsies, permanent RLN palsies, phrenic nerve palsy, seroma/hematoma, and complications classified as other. With the exception of transient bilateral RLN palsy, all of these significant differences between group B + C versus group A were also observed for group B versus group A.

CONCLUSIONS:

Symptoms, malignancy, overall morbidity, hypoparathyroidism, RLN palsy and hematoma are increased in cases of substernal goiter.

• Authors: Mario Testini, Angela Gurrado, Nicola Avenia, Rocco Bellantone, Antonio Biondi, Paolo Brazzarola, Filippo Calzolari, Giuseppe Cavallaro, Giorgio De Toma, Pietro Guida, Germana Lissidini, Michele Loizzi, Celestino Pio Lombardi, Giuseppe Piccinni, Piero Portincasa, Lodovico Rosato, Nora Sartori, Chiara Zugni, Francesco Basile
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 18 Issue 8 Pg. 2251-9 (Aug 2011) ISSN: 1534-4681 [Electronic] United States
• PMID: 21336513 (Publication Type: Journal Article, Multicenter Study)

Topics

• Adolescent
• Adult
• Aged
• Female
• Follow-Up Studies
• Goiter (complications, pathology, surgery)
• Hematoma (etiology, pathology, surgery)
• Humans
• Hypoparathyroidism (etiology, pathology, surgery)
• Male
• Mediastinum (pathology, surgery)
• Middle Aged
• Morbidity
• Postoperative Complications
• Retrospective Studies
• Sternum (pathology, surgery)
• Survival Rate
• Thyroidectomy
• Treatment Outcome
• Vocal Cord Paralysis (etiology, pathology, surgery)
• Young Adult