Abstract
Background: The retrosternal goiter (RSG) is a slow-growing mass often benign in nature; thyroidectomy remains the preferred standard curative treatment. This study aimed to explore the local experience of RSG with respect to the clinical presentation, classifications, management, and outcomes. Method: A retrospective chart review was conducted to include all cases diagnosed with RSG and underwent thyroidectomy between January 1998 and December 2013. Results: A total of 1210 patients underwent thyroidectomy; of which 30 (2.5%) patients were diagnosed to have RSG. The commonly reported symptoms were dyspnea (40%), pain and discomfort (30%), dysphagia (26.7%), and hoarseness (20%). Thirteen patients (43.3%) were completely asymptomatic. The fine-needle aspiration cytology was performed in 22 (73.3%) patients, of whom the majority was benign (77.3%). The grading classification showed that grade 1 is the most frequent (73.3%). Total bilateral thyroidectomy was the most prevailing procedure in 57% cases followed by partial thyroidectomy. All patients underwent retrosternal thyroidectomy through a cervical incision except for one case. Postoperative histopathology showed frequent benign multinodular goiter (83.3%), followed by papillary thyroid cancer (10%) and thyroiditis (6.7%). The most common complication after thyroidectomy was tracheomalacia (13.4%), transient hypocalcemia (10%), and hypoparathyroidism (6.7%). There was no intraoperative or perioperative mortality. Conclusion: RSG is a rare entity often presented with pressure symptoms, mostly involving anterior mediastinum and had a challenging surgical procedure. A large multicenter study is needed to include more cases in order to have a consensus on the definition and classification system for such important clinical goiter presentation.
© 2020 Abdelrahman, Al-Thani, Al-Sulaiti, Tabeb, El-Menyar, licensee HBKU Press.
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2020-05-04
2024-03-29
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References
-
Sahsamanis G, Chouliaras E, Katis K, Samaras S, Daliakopoulos S, Dimitrakopoulos G. Patient-tailored management of an asymptomatic massive substernal goiter presenting as brachiocephalic vein occlusion. Report of a case and review of sternotomy indications. Int J Surg Case Rep. 2017; 31::35–38.
[Google Scholar]
-
Rugiu MG, Piemonte M. Surgical approach to retrosternal goitre: do we still need sternotomy? Acta Otorhinolaryngol Ital. 2009; 29:6:331–338.
[Google Scholar]
-
Di Crescenzo V, Vitale M, Valvano L, Napolitano F, Vatrella A, Zeppa P, et al. Surgical management of cervico-mediastinal goiters: our experience and review of the literature. Int J Surg. 2016;28:S47–S53.
-
Nistor C, Ciuche A, Motas¸ C, Motas¸ N, Bluoss C, Pantile D, et al. Cervico-mediastinal thyroid masses - our experience. Chirurgia (Bucur). 2014; 109:1:34–43.
[Google Scholar]
-
Welman K, Heyes R, Dalal P, Hough S, Bunalade M, Anikin V. Surgical treatment of retrosternal goitre. Indian J Otolaryngol Head Neck Surg. 2017; 69:3:345–350.
[Google Scholar]
-
Mackle T, Meaney J, Timon C. Tracheoesophageal compression associated with substernal goitre. Correlation of symptoms with cross-sectional imaging findings. J Laryngol Otol. 2007; 121:4:358–361.
[Google Scholar]
-
Batori M, Chatelou E, Straniero A. Surgical treatment of retrosternal goiter. Eur Rev Med Pharmacol Sci. 2007; 11:4:265.
[Google Scholar]
-
Katlic MR, Grillo HC, Wang CA. Substernal goiter Analysis of 80 patients from Massachusetts General Hospital. Am J Surg. 1985; 149:2:283–287.
[Google Scholar]
-
deSouza FM, Smith PE. Retrosternal goiter. J Otolaryngol. 1983; 12:6:393e6.
[Google Scholar]
-
Cougard P, Matet P, Goudet P, Bambili R, Viard H, Vaillant B. Les goitres plongeants: 218 cas ope're's. Ann Endocrinol (Paris). 1992; 53::230–235.
[Google Scholar]
-
Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg. 1998; 14:4:393e7.
[Google Scholar]
-
Sanders LE, Rossi RL, Shahian DM, Williamson WA. Mediastinal goiters. The need for an aggressive approach. Arch Surg. 1992; 127:5:609–613.
[Google Scholar]
-
Khairy GA, Al-Saif AA, Alnassar SA, Hajjar WM. Surgical management of retrosternal goiter: Local experience at a university hospital. Ann Thorac Med. 2012; 7:2:57–60.
[Google Scholar]
-
Polistena A, Sanguinetti A, Lucchini R, Galasse S, Monacelli M, Avenia S et al.. Surgical approach to mediastinal goiter: an update based on a retrospective cohort study. Int J Surg. 2016; 28::S42–S46.
[Google Scholar]
-
Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler A, Orgill DP, et al. The PROCESS 2018 Statement: Updating consensus preferred reporting of case series in surgery (PROCESS) guidelines. Int J Surg. 2018;60:279–282.
-
Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008; 6:1:71–76.
[Google Scholar]
-
Randolph GW, Rameau A, Netterville JL. Chapter 7: Surgery of cervical and substernal. In Surgery of the Thyroid and Parathyroid Glands. Second Edition; Boston, MA, USA; 2012.
-
Rodrigues J, Furtado R, Ramani A, Mitta N, Kudchadkar S, Falari S. A rare instance of retrosternal goitre presenting with obstructive sleep apnoea in a middle-aged person. Int J Surg Case Rep. 2013; 4:12:1064–1066.
[Google Scholar]
-
Coskun A, Yildirim M, Erkan N. Substernal goiter: when is a sternotomy required? Int Surg. 2014; 99:4:419–425.
[Google Scholar]
-
Benbakh M, Abou-elfadl M, Rouadi S, Abada RL, Roubal M, Mahtar M. Substernal goiter: experience with 50 cases. Eur Ann Otorhinolaryngol Head Neck Dis. 2016; 133:1:19–22.
[Google Scholar]
-
Ayandipo OO, Afolabi AO, Afuwape OO, Bolaji BE, Salami MA. Experience with managing retrosternal goiters in Ibadan. Nigeria. J West Afr Coll Surg. 2016; 6:1:31–46.
[Google Scholar]
-
Testini M. Nacchiero Miniello S, Lanora AS, Piccinni G, Di Venere B. Management of retrosternal goiters: experience of a surgical unit. Int Surg. 2005; 90:2:61–65.
[Google Scholar]
-
Shen WT, Kepebew E, Duh QY, Clark OH. Predictors of airway complications after thyroidectomy for substernal goiter. Arch Surg. 2004; 139:6:656–660.
[Google Scholar]
-
Nun AB, Soudack M, Best LA. Retrosternal thyroid goiter: 15 years’ experience. Isr Med Assoc J. 2006; 8:2:106–109.
[Google Scholar]
-
Grainger J, Saravanappa N, D'Souza A, Wilcock D, Wilson PS. The surgical approach to retrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg. 2005; 132:6:849–851.
[Google Scholar]
-
Nervi M, Iacconi P, Spinelli C, Janni A, Miccoli P. Thyroid carcinoma is intrathoracic goiter. Langenbecks Arch Surg. 1998; 383:5:337–339.
[Google Scholar]
-
Cohen JP, Cho HT. Surgery for substernal goiters. Oper Techn Otolaryngol Head Neck Surg. 1994; 5:2:118–125.
[Google Scholar]
-
Mercante G, Gabrielli E, Pedroni C, Formisano D, Bertolini L, Nicoli F, et al. CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach. Head Neck. 2011; 33:6:792–799.
[Google Scholar]
-
-
Erbil Y, Bozbora A, Barbaros U, Ozarmagan S, Azezli A, Molvalilar S. Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today. 2004; 34:9:732–736.
[Google Scholar]
-
Prades JM, Dumollard JM, Timoshenko A, Chelikh L, Michel F, Estour B. Multinodular goiter: surgical management and histopathological findings. Eur Arch Otorhinolaryngol. 2002; 259:4:217–221.
[Google Scholar]
-
Landerholm K, Järhult J. Should asymptomatic retrosternal goitre be left untreated? A prospective single-centre study. Scand J Surg. 2015; 104:2:92–95.
[Google Scholar]
-
Abboud B, Sleilaty G, Mallak N, Abou Zeid H, Tabchy b Morbidity and mortality of thyroidectomy for substernal goiter. Head Neck. 2010; 32:6:744–749.
[Google Scholar]
-
Conzo G, Calò PG, Gambardella C, Tartaglia E, Mauriello C, Della Pietra C, et al. Controversies in the surgical management of thyroid follicular neoplasms. Retrospective analysis of 721 patients. Int J Surg. 2014; 12::S29–S34.
[Google Scholar]
-
Ozdemir A, Hasbahceci M, Hamaloglu E, Ozenic A. Surgical treatment of substernal goiter. Int Surg. 2000; 85:3:194–197.
[Google Scholar]
-
Sakkary MA, Abdelrahman AM, Mostafa AM, Abbas AA, Zedan MH. Retrosternal goitre: the need for thoracic approach based on CT findings: surgeon's view. J Egypt Natl Canc Inst. 2012; 24:2:85–90.
[Google Scholar]
-
Raffaelli M, De Crea C, Ronti S, Bellantone R, Lombardi CP. Substernal goiters: incidence, surgical approach, and complications in a tertiary care referral center. Head Neck. 2011; 33:10:1420–1425.
[Google Scholar]
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