title: Recurrent laryngeal nerve palsy and substernal goiter. An Italian multicenter study.
abstract: The aim of this retrospective multicenter study was to verify whether the substernal goiter and the type of surgical access could be risk factors for recurrent laryngeal nerve palsy during total thyroidectomy. Between 1999-2008, 14,993 patients underwent total thyroidectomy. Patients were divided into three groups: group A (control; n=14.200, 94.7%), cervical goiters treated through collar incision; group B (n=743, 5.0%) substernal goiters treated by cervical approach; group C (n=50, 0.3%) in which a manubriotomy was performed. Transient and permanent unilateral palsy occurred significantly more frequently in B+C vs. A (P≤.001) and in B vs. A (P≤.001). Transient bilateral palsy was significantly more frequent in B+C vs. A (P≤.043) and in C vs. A (P≤.016). Permanent bilateral palsy was significantly more frequent in B+C vs. A (P≤.041), and in B vs. A (P≤.037). Extension of the goiter into the mediastinum was associated to increased risk of recurrent nerve palsy during total thyroidectomy.
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy. Electronic address: mario.testini@uniba.it.
authors.forename: M
authors.initials: M
authors.lastname: Testini
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gurrado
authors.affiliation: Department of Surgery, Unit of Endocrine Surgery, University Medical School "Cattolica del Sacro Cuore", Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bellantone
authors.affiliation: Department of Surgery, Unit of General Surgery, University Medical School of Verona, Verona, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Brazzarola
authors.affiliation: Department of Neurological and Psychiatric Sciences, Unit of Physical and Rehabilitation, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cortese
authors.affiliation: Department of Surgery, Unit of General Surgery "P. Valdoni", University Medical School "La Sapienza", Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: De Toma
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Fabiola Franco
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lissidini
authors.affiliation: Department of Surgery, Unit of Endocrine Surgery, University Medical School "Cattolica del Sacro Cuore", Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Pio Lombardi
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Medicine "A. Murri" University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Minerva
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Meo
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pasculli
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Piccinni
authors.affiliation: Department of Surgery, Endocrine Surgical Unit, Ivrea Hospital, Ivrea, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Rosato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006045:Goiter, Substernal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007558:Italy; D008297:Male; D008482:Mediastinum / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology*; D055815:Young Adult
keywords: Cervico-mediastinal goiter; Recurrent laryngeal nerve palsy; Substernal goiter; Thyroid surgery; Total thyroidectomy