title: [Surgical management of retrosternal goitre: experience of a Moroccan centre].
abstract: OBJECTIVE
  This was a retrospective study reviewing 93 cases of retrosternal goitre (RG) operated in our department, with the aim of describing epidemiological and clinical data and discussing the surgical challenges of RG.
  
  
  METHODS
  From January 2004 to December 2012, 35 men and 58 women presenting with RG had surgery. Eighty-nine cases (95.7%) underwent cervicotomy, and a sternotomy was mandatory in 4 cases (4.3%). Laryngoscopy was performed in all cases. A second preoperative laryngoscopy by a senior was mandatory for patients with hoarseness or dyspnea even if the initial laryngeal exam was normal.
  
  
  RESULTS
  A cervical mass was noted in 81 cases (87.1%), dyspnea in 17 cases (18.3%), dysphagia in 2 cases (2.1%), hoarseness in 7 cases (7.5%), partial vena cava syndrome in 2 cases and recurrent goitre was noted in 2 cases (2.1%) after previous thyroid resection. Mediastinal extension was on the left side in 47 cases (50.5%), on the right side in 29 cases (31.2%) and bilateral in 17 cases (18.3%). A total thyroidectomy was performed in 86 cases (92.5%) and a unilateral isthmo-lobectomy was performed in 7 cases (7.5%). Mean goitre size was 9.3 cm. Postoperative complications were present in 9 cases (9.7%), 3 cases with hypoparathyroidism (3.2%) and 4 cases (4.3%) of recurrent nerve injury. There was no postoperative death. The histological study objectified 88 cases of multiheteronodular goitre, 4 cases of Basedow thyroid, and 1 case of thyroid carcinoma (papillary carcinoma).
  
  
  CONCLUSIONS
  Our experience confirms that cervicotomy often allows removing goitre with a mediastinal extension. However, intraoperative enlargement may be necessary, with increased operating time, hospital stay and morbidity.
authors.affiliation: Department of Thoracic Surgery, Mohamed V Military Teaching Hospital and faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Souissi. Rabat, Morocco. Electronic address: hamoumimassine@hotmail.fr.
authors.forename: Massine
authors.initials: M
authors.lastname: El Hammoumi
authors.affiliation: Department of Thoracic Surgery, Mohamed V Military Teaching Hospital and faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Souissi. Rabat, Morocco.
authors.forename: Fayçal
authors.initials: F
authors.lastname: El Oueriachi
authors.affiliation: Department of Thoracic Surgery, Mohamed V Military Teaching Hospital and faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Souissi. Rabat, Morocco.
authors.forename: Adil
authors.initials: A
authors.lastname: Arsalane
authors.affiliation: Department of Thoracic Surgery, Mohamed V Military Teaching Hospital and faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Souissi. Rabat, Morocco.
authors.forename: El Hassane
authors.initials: el H
authors.lastname: Kabiri
mesh_terms: D005260:Female; D006045:Goiter, Substernal / Q000601:surgery*; D006801:Humans; D008297:Male; D009018:Morocco; D012189:Retrospective Studies
keywords: Bocio; Cervicotomy; Cervicotomía; Esternotomía; Goitre; Mediastinal; Mediastino; Sternotomy