title: Substernal goiters: incidence, surgical approach, and complications in a tertiary care referral center.
abstract: BACKGROUND
  Surgery is the treatment of choice for substernal goiters, but there are still some controversies on their definition, the surgical approach, and the complications rate. We analyzed our experience in a tertiary care referral center.
  
  
  METHODS
  Among a series of 2263 patients who underwent thyroidectomy between 2004 and 2008, 355 patients with substernal goiter were identified. A control group of 355 patients with cervical goiters operated on during the same period was selected. The operative and pathological characteristics and the complications rate of the 2 groups were compared.
  
  
  RESULTS
  Only 2 patients (0.6%) required an extracervical approach (1 primary intrathoracic goiter and 1 recurrent carcinoma). No significant difference was found in terms of complications between the 2 groups.
  
  
  CONCLUSIONS
  The cervical approach can be safely performed in almost all the patients with substernal goiters. An extracervical procedure has very limited indications. Substernal goiter is not associated with increased complications rate.
authors.affiliation: Department of Surgery, Division of General and Endocrine Surgery, Università Cattolica del S. Cuore, Rome, Italy. marcoraffaelli@rm.unicatt.it
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.forename: Carmela
authors.initials: C
authors.lastname: De Crea
authors.forename: Simona
authors.initials: S
authors.lastname: Ronti
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.forename: Celestino P
authors.initials: CP
authors.lastname: Lombardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006045:Goiter, Substernal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000453:epidemiology; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult