title: Surgical management of mediastinal goiter in the elderly.
abstract: OBJECTIVE
  Mediastinal goiter (MG) is characterized by compression symptoms such choking, dyspnea, sleeping apnea and dysphagia. It is significantly observed in elderly patients who due to comorbidity are associated to increased surgical risk. Total thyroidectomy is indicated to treat tracheal compression. Cervicotomy is the most used surgical access. AIM of the study was the evaluation of the role of surgery in the treatment of MG in the elderly.
  
  
  METHODS
  A retrospective analysis of twenty-eight-years on 1721 (390 over 80-years-old) cases of MG in a referral center for endocrine surgery was carried out. CT was used as a standard in the preoperative study. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected cases via sternotomy or thoracotomy. Clinical records were examined.
  
  
  RESULTS
  Patients were divided into two groups: older and younger than 80-years-old. Total thyroidectomy was performed in all cases and via a cervical approach in almost 99% of patients. Tracheal dislocation and tracheomalacia were prevalent in elderly patients and were treated conservatively. Benign struma was observed in 1463 patients and a carcinoma in 258. Larger thyroid weight was observed in the elderly. The rate of complications was similar between groups.
  
  
  CONCLUSIONS
  Total thyroidectomy via cervical approach is the treatment of choice for MG in the elderly. It should be treated only in referral centers with adequate caution for elderly patients to achieve complete cure with limited complications.
authors.affiliation: Department of Surgical and Biomedical Sciences, University of Perugia, Italy; Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: apolis74@yahoo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: massimo.monacelli@mail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Monacelli
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: robertalucchini@alice.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lucchini
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: triolaroberta@gmail.com.
authors.forename: Roberta
authors.initials: R
authors.lastname: Triola
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: c.claudia81@alice.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Conti
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: stefano_avenia@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Avenia
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: rondellif@hotmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: walterbugiantella@alice.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Bugiantella
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: ivanbarillaro@gmail.com.
authors.forename: Ivan
authors.initials: I
authors.lastname: Barillaro
authors.affiliation: Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: alessandrosanguinetti@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
authors.affiliation: Department of Surgical and Biomedical Sciences, University of Perugia, Italy; Unit of Endocrine Surgery, S. Maria University Hospital, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006042:Goiter / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D013908:Thoracotomy; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Cervical approach; Complications; Elderly; Mediastinal goiter; Thyroidectomy