title: Surgical approach to mediastinal goiter: An update based on a retrospective cohort study.
abstract: OBJECTIVE
  Surgery for mediastinal goiters (MG) is indicated for compression symptoms and risk of malignancy. Total thyroidectomy by cervicotomy is universally considered the standard surgical approach to MG. In selected cases sternotomy or a thoracotomy are used. Options of the operative technique and practical surgical problems are analysed.
  
  
  METHODS
  A retrospective analysis of twenty-eight-years on 1767 cases of MG in a referral centre for endocrine surgery was carried out. All patients underwent standard preoperative study and CT based surgical planning. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected case via sternotomy or thoracotomy. Clinical records were examined.
  
  
  RESULTS
  Total thyroidectomy was performed in all cases. A cervical approach was used in almost 99% of patients. Significant shorter surgical time was observed for surgery via the cervical approach vs sternotomy and thoracotomy. Benign struma was observed in 1503 patients and a carcinoma in 264. We observed postoperative bleeding in 0.5% of cases, permanent monolateral recurrent laryngeal nerve palsy occurred in 1.3%, bilateral palsy in 0.6%, transient and permanent hypoparathyroidism in 14% and 4.1% respectively.
  
  
  CONCLUSIONS
  MG may be approached by a cervicotomic access only with a clear knowledge of potential risk and complications of the surgical manoeuvres. Sternotomy or of a thoracotomy are indicated only in selected cases but their inapplicability may be really dangerous in those MG not otherwise resectable. MG should be referred only to specialized centre.
authors.affiliation: Department of General Surgery and Surgical Disciplines, University of Perugia, 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: alessandrosanguinetti@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
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: sergio.galasse@gmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Galasse
authors.affiliation: Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: massimo.monacelli@gmail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Monacelli
authors.affiliation: Medical School, University of Perugia, 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: 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: walterbugiantella@alice.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Bugiantella
authors.affiliation: Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: rondellif@hotmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.affiliation: Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: roberto.cirocchi@unipg.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Department of General Surgery and Surgical Disciplines, University of Perugia, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery; D005260:Female; D006045:Goiter, Substernal / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000601:surgery; D012017:Referral and Consultation; D012189:Retrospective Studies; D056346:Sternotomy; D013908:Thoracotomy; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D014826:Vocal Cord Paralysis / Q000601:surgery
keywords: Cervical approach; Mediastinal goiter; Sternotomy; Thoracotomy; Thyroidectomy