TITLE:
Surgical Approaches to Retrosternal Goiter, When Sternotomy Is Mandatory? National Cancer Institute Experience (NCI), Cairo University, Egypt
AUTHORS:
Ahmed El Sayed Fathalla, Bahaa El Din Ahmed
KEYWORDS:
Retrosternal Goiter, Mediastinal, Sternotomy, Cervicotomy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.4,
April
28,
2016
ABSTRACT: Background: Retrosternal goiters (RG) are those lesions extending
to occupy the thoracic cavity. They carry a surgical risk due to distorted
anatomy, the minimal access, and the potential for great vessels or pleural
injury. No other effective therapeutic alternative to surgery exists.
Cervicotomy is still the surgical approach of choice, although a form of
sternotomy may always be necessary for field extension and safe gland delivery.
Materials and Methods: This is a single institution combined
retrospective & prospective study including retrospective analysis of all
cases presenting to the NCI, Cairo University with RG candidate for surgery
between Jan. 2008 until the end of Dec. 2012, and a prospective study of all
cases with the same presentation presenting to the NCI between Jan. 2013 until
the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the
clinico-pathological characteristics, the presentation, work-up,
surgical approaches and postoperative complications of RG. Results: 42
patients were included & were divided into benign (34 patients, 80.9%) and
malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19
to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration
of symptomatology was 23 months ranging (6 - 53 months). 23 patients (54.7%)
were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size
was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients
(73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were
hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest
approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done
in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy
& 4 cases (9.5%) received postoperative radioactive iodine. No
perioperative mortality occurred & the overall morbidity was 6 cases (14.2%)
in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The
median follow up period was 17.5 months. The median overall survival (OS) was
39.4 months and the median disease free
survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy
is a safe favorable approach to remove a RG. Intraoperative field extension up
to a form of sternotomy may be necessary for gland delivery with increasing
operating time, hospital stay and morbidity. Postoperative morbidity is mainly
due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism
which is mainly increased when sternotomy is performed.