[Substernal goitre. Personal experience].
BACKGROUND
Aim of the study is to discuss the diagnostic and therapeutic problems of substernal goiter (SG).


METHODS
The Authors retrospectively analyzed 12 patients (3.1%) with substernal goiters among 379 patients undergoing surgical treatment for thyroid diseases from January 2000 to 2005, and evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications.


RESULTS
The most common symptoms were a cervical mass (100%) and dyspnea (16%), but 50% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 100% of the patients. The AA performed total thyroidectomy and operated through a cervical incision in all the patients. There was operative mortality (1 case: = 8%), 2 (16%) patients suffered temporary hypoparathyroidism; no patients suffered transient vocal cord paralysis. Malignancy was diagnosed by histopathological examination in 2 patients (16%).


CONCLUSIONS
The presence of a substernal goiter is considerd as a sole indication for surgery. Surgical treatment of SG requires a diagnosis that exactly defines the extent of the lesion. A correct choice of surgical access and scrupulous operating technique are likewise of paramount importance to reduce the risk of severe compressive complications. Most retrosternal goiters can be resected through an entirely cervical approach with a low complication rate. On rare occasions a median sternotomy or a sternal split will be required to permit a safe and complete thyroidectomy.
Sciumè
Carmelo
C
Università degli Studi di Palermo, Azienda Ospedaliero-Universitaria Policlinico Paolo Giaccone Dipartimento di Chirurgia Generale, d'Urgenza e dei Trapianti d'Organo, Sezione di Chirurgia Generale ad Indirizzo Toracico. carmesci@hotmail.com
Geraci
Girolamo
G
Pisello
Franco
F
Li Volsi
Francesco
F
Facella
Tiziana
T
Modica
Giuseppe
G
D000328:Adult; D000368:Aged; D005260:Female; D006045:Goiter, Substernal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013965:Thyroidectomy