Should asymptomatic retrosternal goitre be left untreated? A prospective single-centre study.
OBJECTIVE
Retrosternal goiter may cause symptoms of airway obstruction and dysphagia, but often it is asymptomatic and is increasingly detected incidentally with imaging investigations. Consensus has been reached that sternotomy is not necessary in most cases, as a collar incision normally suffices. Yet, surgery for retrosternal goiter is associated with more complications than cervical goiter. There is controversy over whether patients with asymptomatic retrosternal goiter should be operated. Proponents argue that retrosternal goiter may be a risk for thyroid cancer and may progress to later cause symptoms, although clear evidence is missing.


METHODS
Between 1984 and 2012, 132 patients underwent surgery for benign retrosternal goiter. Preoperatively, the benign nature was clinically apparent and confirmed by fine needle cytology in most cases.


RESULTS
Sternotomy was required in only 4 of the 132 operations. Three patients died in the postoperative period. The risk of morbidity and mortality was 16.7% in 60 patients with compression symptoms and 13.9% in 72 patients without compression symptoms (P = 0.808). Histology revealed no case of unsuspected cancer.


CONCLUSIONS
Surgery for retrosternal goiters involves a higher risk for complications than do cervical goiters, and the risk does not differ between patients with and without symptoms. This, and the fact that no patient in this study had unsuspected cancer, calls into question the rationale for surgery in patients with asymptomatic retrosternal goiter without suspected cancer.
Department of Surgery, Ryhov County Hospital, Jönköping, Sweden kalle.landerholm@lj.se.
K
K
Landerholm
Department of Surgery, Ryhov County Hospital, Jönköping, Sweden Department of Surgery, Highland Hospital, Eksjö, Sweden.
J
J
Järhult
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006045:Goiter, Substernal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056346:Sternotomy / Q000379:methods*; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult
Retrosternal goiter; complications to surgery; intrathoracic goiter; nodular goiter; recurrent laryngeal nerve injury; substernal goiter; surgical treatment