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

Mohamed Korany^1, , Mohamed Allaa² and Hussein Fakhry³

¹Departments of General Surgery, Assiut University, Assiut, Egypt

²Departments of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt

³Departments of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

Cite this paper:
Mohamed Korany, Mohamed Allaa and Hussein Fakhry. Impact of Midline Sternotomy on Surgical Outcome for Treatment of Retrosternal Goitre. Global Journal of Surgery. 2015; 3(1):4-7. doi: 10.12691/js-3-1-2

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.

Keywords:
Thyroid goitre Retrosternal Sternotomy Surgical Outcome

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Haller, A. Disputatones Anatomica selectae. Gottingen: Vendenhocek; 1749. p. 96.
[2]	Desouza, Smith P.E. Reterosternal goitre. J. Otolaryngol 1983; 12: 393-6.
[3]	Allo, M.D., Thompson, N.W. Rational for the operative management of substernal goitre. Surgery 1983; 94: 969-77.
[4]	Wu, M.H., Chen, K.Y., Lia, K.Y., et al. Primary intrathoracic goitre. J Fermos. Med. Assoc 2006; 105: 160-3.
[5]	Shen, W.T., Kepebew, E., Duh, Q.Y., Clark OH. Predictors of airway complications after thyroidectomy for substernal goitre. Arch. Surg. 2004; 139: 656-60.
[6]	Moron, J.G., Singer, J.A., Sardi, A. Retrosternal goitre: A six year institutional review. Am Surg. 1998, 64, 245-51.
[7]	Hedayati, N., McHenry, C.R. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg. 2002. 68: 245-251.
[8]	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: 358-61.
[9]	Pallov, J.S., Tim, B., Sanjay, G. et al. Large retrosternal goitre: A diagnostic and management dilemma. Heart Lung circ. 2006, 15 (2): 151-152.
[10]	Page, C., Strunski, V. Cervicothoracic goitre: An anatomical and or radiological definition? Report of 233 Surgical cases. J Laryngol Otol 2007; 121: 1083-7.
[11]	Hedayati, N., McHenry, C.R. The clinical presentation and operative management of Nodular and diffuse substernal thyroid disease. Am. Surg. 2002; 68: 245-51.
[12]	White, M.L., Doherty, G.M., Gauger, P.G. Evidence based surgical management of substernal goitre. World J Surg. 2008; 32: 1285-300.
[13]	Newman, E., Shaha, A.R. Substernal goitre. J. Surg. Oncol. 1995; 60: 207-12.
[14]	Hashmi, S.M., Premachandra, D.J., Bennett, A.D., Parry, W. Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity and a review of the English Literature. J Laryngol Otol 2006; 120: 644-9.
[15]	Cougard, P., Mate, P., Goudet, P., et al. Les goitres plongeants: 214 cas operas. Ann Endocrinol (paris) 1992; 53: 230-5.
[16]	Dahan, M., Gaillard, J., Eschapasse, H. Surgical treatment of goitres with intrathoracic development. In: Delarue M, editor. International trends in general thoracic surgery. Vol.5. thoracic Surgery: Frantiers and uncommon neoplasms. St. louis: Mosby; 1989. p. 240-6.
[17]	Vadasz, P., Kotsis, L. Surgical aspects of 175 mediastinal goitres. Sur J Cardiothoracic Surg. 1998; 14: 393-7.
[18]	Sancho, J.J., Karaimps, J.L., Sanchez-Blanco, J.M, et al. Increased mortality and morbidity associated with thyroidectomy for intrathoracic goitres reaching the carina trachea. Archi. Surg. 2006; 141: 82-5.
[19]	Huins, C.T., Georgalas, C., Mechrzad, H., Tolley, N.S. A new classification system for retrosternal goitre based on a systemic review of its complications and management. Int. J Surg. 2008; 6: 71-6.
[20]	Maruotti. R.A., Zannini, P., Viani, P. et al. Surgical treatment of substernal goitres Int. Surg. 2009 Jan-Mar, 76 (1): 12-7.
[21]	De parrot, M., Fadel, E., Mercier, O., et al. Surgical management of mediastinal goitres when in a sternotomy required? Thoracic-Cardiovasc. Surg. 2007 Feb; 55 (1): 39-43.
[22]	Flati, G., DeGiacomo, T., Porowska, B., et al. Surgical management of substernal goitre when is sternotomy inevitable? Clin. Ter. 2009; 156:191-5.
[23]	White, M.L., Deherty, G.M., Gauger, P.G. Evidence-based surgical management of substernal goitre. World J. Surg 2008; 32:1285-300.
[24]	Fabrizio, S., Federico A., Panagiotis, P., et al. Is sternotomy always necessary for the treatment of mediatinal ectopic thyroid goitre? Ann. Ital. Chir., 2014; 85: 304-307.
[25]	Malvemyr P., Liljeberg N., Hellström M., Muth A. Computed tomography for preoperative evaluation of need for sternotomy in surgery for retrosternal goiter. Langenbeck's Arch Surg. 2015; 4: 1268-75.
[26]	Coskun, A., Yildirim, M., Erkan, N. Substernal goitre: when is a sternotomy required? Int. Surg. 2014 Jul-Aug; 00 (4): 419-25.
[27]	Gamal, A.K., Abdulaziz A.A., Sami, A.A., Waseem, M.H. Surgical management of retrosternal goitre: local experience at a university hospital Annals of thoracic Medicine, 2012, 7, 2: 57-60.
[28]	Fauque, R., Marcos. M., Brian, F. Radiologically predicting when a sternotomy May be required in the management of reterosternal goitres. Annals of otorhinolaryngology 2014, 26-37.