Abstract
ObjectiveIntrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear.This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy.MethodsIn a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500).ResultsAn intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%).ConclusionIn patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy.Level of evidenceIV
Highlights
There is no uniform definition of an intrathoracic goiter, many agree that a thyroid gland volume over 50% below the thoracic inlet is an important criterion [1,2,3,4]
All consecutive adult patients undergoing thyroid surgery at the Onze Lieve Vrouw (OLV) hospital in Aalst, Belgium were enrolled in a prospective cohort to evaluate morbidity and outcome in a tertiary referral center
Patients undergoing cervicotomy and cervicosternotomy were significantly older than the reference standard thyroidectomy group
Summary
There is no uniform definition of an intrathoracic goiter, many agree that a thyroid gland volume over 50% below the thoracic inlet is an important criterion [1,2,3,4]. Extended author information available on the last page of the article absence of a clear definition, the exact prevalence is difficult to determine. In patients undergoing thyroid surgery, the prevalence of intrathoracic goiters is approximately 1–21% [1, 2, 5]
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