Impact of Midline Sternotomy on Surgical Outcome for Treatment of Retrosternal Goitre

Abstract

Retrosternal goitre is defined as goitre with a portion of its mass more than 50% located in the mediastinum. Surgical removal is the treatment of choice and in most cases; the goitre can be removed via cervical approach. This work aimed to evaluate the impact, value and safety of midline sternotomy on the treatment of retrosternal goitre. In the surgical department, Assiut University Hospital between March 2009 and December 2014, 1228 patient underwent thyroidectomy. Only 43 patients (3.5%) of them had retrosternal extension, 27 (62.7%) females and 16 (37.3%) males and the mean age of the patients: 54 years (range 35-75). History, clinical examination, preoperative investigation in the form of plain x-ray chest, neck ultrasonography, CT scan of the neck and chest, thyroid scanning were done when needed. All the removed glands were examined histopathologically. Intraoperative and postoperative complications were recoded. All patients followed for 6 months. The study included 43 patients; the most recorded symptoms were the dyspnea (63.3%), dysphagia (23.3%) and SVC obstruction (13.3%). All patients were presented with cervical mass (30 patients were symptomatic, 13 patients were asymptomatic). CT scan revealed the goitres were right sided in 23 (53.4%), left sided in 15 (34.8%) and bilateral in 5 (11.6%) of the patients. Thirty two patients (74.4%) were treated via cervical approach, 10 of them (31.2%) presented CT evidence of descend below the aortic arch. Eleven patients (25.5%) undergone sternotomy in which the C.T scan showed evidence of the goitre reached to the carina of the trachea. postoperative complications occurred in 8 (18.6%) patients (7 (16.2%) in the cervical group and one (2.3%) in the sternotomy group). Sternotomy is generally accepted for the removal of retrosternal goitres in the anterior mediastinum. It is safe procedure and able to dominate retrosternal goitre especially its vascular pedicle without complication.