title: Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients.
abstract: OBJECTIVE
  To compare the outcome in patients with cervical goiters and cervicomediastinal goiters (CMGs) undergoing total thyroidectomy using the cervical or extracervical approach.
  
  
  METHODS
  This was a retrospective study conducted at six academic departments of general surgery and one endocrine-surgical unit in Italy. The study population consisted of 19,662 patients undergoing total thyroidectomy between 1999 and 2008, of whom 18,607 had cervical goiter (group A) and 1055 had CMG treated using a cervical approach (group B, n = 986) or manubriotomy (group C, n = 69). The main parameters of interest were symptoms, gender, age, operative time, duration of drain, length of hospital stay, malignancy and outcome.
  
  
  RESULTS
  A split-sternal approach was required in 6.5% of cases of CMG. Malignancy was significantly more frequent in group B (22.4%) and group C (36.2%) versus group A (10.4%; both P < .001), and in group C versus group B (P = .009). Overall morbidity was significantly higher in groups B + C (35%), B (34.4%) and C (53.5%) versus group A (23.7%; P < .001). Statistically significant increases for group B + C versus group A were observed for transient hypocalcemia, permanent hypocalcemia, transient recurrent laryngeal nerve (RLN) palsies, permanent RLN palsies, phrenic nerve palsy, seroma/hematoma, and complications classified as other. With the exception of transient bilateral RLN palsy, all of these significant differences between group B + C versus group A were also observed for group B versus group A.
  
  
  CONCLUSIONS
  Symptoms, malignancy, overall morbidity, hypoparathyroidism, RLN palsy and hematoma are increased in cases of substernal goiter.
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Section of General Surgery and Clinical Oncology, University Medical School of Bari, Bari, Italy. mario.testini@chirgen2.uniba.it
authors.forename: Mario
authors.initials: M
authors.lastname: Testini
authors.forename: Angela
authors.initials: A
authors.lastname: Gurrado
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.forename: Antonio
authors.initials: A
authors.lastname: Biondi
authors.forename: Paolo
authors.initials: P
authors.lastname: Brazzarola
authors.forename: Filippo
authors.initials: F
authors.lastname: Calzolari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Toma
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Germana
authors.initials: G
authors.lastname: Lissidini
authors.forename: Michele
authors.initials: M
authors.lastname: Loizzi
authors.forename: Celestino Pio
authors.initials: CP
authors.lastname: Lombardi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Piccinni
authors.forename: Piero
authors.initials: P
authors.lastname: Portincasa
authors.forename: Lodovico
authors.initials: L
authors.lastname: Rosato
authors.forename: Nora
authors.initials: N
authors.lastname: Sartori
authors.forename: Chiara
authors.initials: C
authors.lastname: Zugni
authors.forename: Francesco
authors.initials: F
authors.lastname: Basile
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006406:Hematoma / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008482:Mediastinum / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D012189:Retrospective Studies; D013249:Sternum / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013965:Thyroidectomy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D055815:Young Adult