title: Increased mortality and morbidity associated with thyroidectomy for intrathoracic goiters reaching the carina tracheae.
abstract: OBJECTIVE
  Complications associated with thyroidectomy for intrathoracic goiters have been underestimated because of the lack of a precise definition of high-risk patients.
  
  
  METHODS
  Retrospective multicenter multinational review of medical records and radiographic images of patients who underwent thyroidectomy for intrathoracic goiters reaching the carina tracheae. Demographic, clinical, operative, anatomical, and pathological data were recorded.
  
  
  RESULTS
  There were 35 patients (mean +/- SE age, 63 +/- 11 years) included in the study. In 4 patients, the goiter was asymptomatic; 10 patients had dysphagia, 24 patients had dyspnea, and 3 patients had superior vena cava syndrome. A median sternotomy was required in 12 patients and a right-sided thoracotomy in 1 patient. The mean +/- SE operative time was 145 +/- 72 minutes (range, 50-360 minutes). Transient hypoparathyroidism developed in 13 patients. Four patients experienced transient hoarseness, and 1 patient had permanent vocal cord paralysis. There were no significant differences between the proportion of patients who underwent or did not undergo sternotomy or thoracotomy regarding vocal cord dysfunction (2 [15%] of 13 patients vs 3 [13%] of 22 patients) or hypoparathyroidism (5 [38%] of 13 vs 6 [28%] of 22 patients). The mean postoperative hospital stay was 10 days (range, 2-84 days). Four patients required reoperation. Two patients died. Nine of 14 patients with thyroid glands weighing at least 260 g required sternotomy vs 3 of 14 patients with thyroid glands weighing less than 260 g (P = .02). Overall, 18 [52%] of 35 patients were discharged without any complication.
  
  
  CONCLUSIONS
  Intrathoracic goiters reaching the carina tracheae carry a high unreported risk of sternotomy, postoperative complications, reoperation, and death.
authors.affiliation: Unitat de Cirurgia Endocrina, Hospital del Mar, Passeig Maritim 25-29, E-80003 Barcelona, Spain.
authors.forename: Joan J
authors.initials: JJ
authors.lastname: Sancho
authors.forename: Jean L
authors.initials: JL
authors.lastname: Kraimps
authors.forename: Jose M
authors.initials: JM
authors.lastname: Sanchez-Blanco
authors.forename: Alvaro
authors.initials: A
authors.lastname: Larrad
authors.forename: Jose M
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: Pedro
authors.initials: P
authors.lastname: Gil
authors.forename: Helene
authors.initials: H
authors.lastname: Gibelin
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pereira
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitges-Serra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006045:Goiter, Substernal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects* / Q000401:mortality