title: Surgical strategies in cervico-mediastinal goiters.
abstract: OBJECTIVE
  We retrospectively studied clinical picture, diagnosis, treatment and complications of patients with cervico-mediastinal goiter who underwent surgery.
  
  
  METHODS
  Sixty-three patients underwent surgical treatment for cervico-mediastinal goiter in the last 10 years. Thirty-two patients (50.8%) had cervico-mediastinal goiter, 24 patients (33.3%) had mediastino-cervical goiter and 7 patients (11.1%) had mediastinal goiter. Forty-seven cases were prevascular goiters and 16 were retrovascular goiters. We performed total thyroidectomy in 25 patients, subtotal thyroidectomy in 31 patients and in 7 cases the resection of residual goiter. In 50 patients we used a cervical approach, in 12 patients the cervical incision was combined with median sternotomy (6 in total) and in 1 patient with transverse sternotomy.
  
  
  RESULTS
  Three patients (4.7%) died in the postoperative period (2 cardio-respiratory failure and 1 pulmonary embolism). The histologic study revelead 5 (7.9%) carcinomas. Postoperative complications were: dyspnea in 7 cases (11.1%), transient vocal cord paralysis in 5 patients (7.9%), temporary hypoparathyroidism in 6 patients (9.5%) and kidney failure in 1 case (1.6%).
  
  
  CONCLUSIONS
  Cervicotomy is the approach of choice but in some limited cases (carcinoma, thyroiditis, retrovascular goiter, ectopic goiter) the sternotomy should be performed. Postoperative mortality and morbidity is very low, independent of surgical techniques.
authors.affiliation: Dipartimento di Scienze Anestesiologiche Chirurgiche e dell'emergenza, Cattedra di Chirurgia Toracica II, Università degli Studi di Napoli, Napoli, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Santini
authors.forename: A
authors.initials: A
authors.lastname: Fiorello
authors.forename: E
authors.initials: E
authors.lastname: Di Lieto
authors.forename: V G
authors.initials: VG
authors.lastname: Di Crescenzo
authors.forename: G
authors.initials: G
authors.lastname: D'aniello
authors.forename: G
authors.initials: G
authors.lastname: Vicidomini
authors.forename: A
authors.initials: A
authors.lastname: Perrone
authors.forename: V
authors.initials: V
authors.lastname: Pastore