P-201EXTENDED TRANSCERVIVAL APPROACH WITH ELEVATION OF THE STERNUM FOR RESECTION OF THE THYROID CANCER METASTATIC NODES AFTER PREVIOUS THYROIDECTOMY: ANALYSIS OF THE LARGEST REPORTED SERIES

Abstract

Objectives: Analysis of the operative technique and the results of the minimally invasive transcervical approach for resection of the mediastinal metastatic lymph nodes of the thyroid cancer. Methods: Clinical diagnosis of the metastatic spread to the mediastinal nodes was based on the elevated thyreoglobulin (Tg) level for papillary and follicular cancer, elevated calcitonin (Ct) level for medullary cancer and on visualization of the suspicious nodules on the imaging studies (CT, PET/CT, scintigraphy). The patients with retrosternal goiter and ectopic mediastinal goiter were excluded. Operative technique included elevation of the sternum with a hook connected to special frame (Rochard bar, Aesculap-Chifa, Nowy Tomysl, Poland) which widened the access to the mediastinum. The mediastinal nodes were resected en-bloc with the surrounding fatty tissue. The dissection was guided by the previous imaging studies. Results: Overall, there were 94 patients operated on in the period from 1 July 2007 to 31 December 2012. In 5 patients (5.3%) concomitant thyroidectomy was performed. Re-resection of the recurrent metastases was performed in 7 patients. In 43 patients there was single mediastinal nodal station involved and in 51 patients there were multiple (2-5) nodal stations involved. Resection was incomplete in 5 patients (5.3%). Conversion to sternotomy/thoracotomy was necessary in 3 patients (3.2%). In 5 patients (5.3%) concomitant partial sternectomy was performed for sternal metastasis. There was no mortality and 8.9% morbidity. Conclusions: Analysis of this largest reported series of the mediastinal metastases of the thyroid cancer showed that transcervical approach with elevation of the sternum enabled minimally invasive, safe and effective resection with sternotomy or thoracotomy avoided in almost all patients. Detailed imaging studies of chest should be a standard of preoperative evaluation of patients with thyroid cancer. Disclosure: All authors have declared no conflicts of interest. Interactive CardioVascular and Thoracic Surgery