[Personal experience with surgery of retrosternal goiter]

Abstract

Background: Retrosternal goitre has its specific features: a clinical picture with elements of compression, an increased percentage of malignant conversion, a technically more pretentious operation with an increased number of complications etc. Data in the literature are not uniform. The objective of the presented work was to assemble information in a large group of operated patients.

Methods and results: The authors evaluated retrospectively operations of retrosternal goitres from two clinical departments. Of 716 patients operated on account of goitre 87 (21.1%) had retrosternal goitre. Women were affected more frequently (84%) than men (16%), ratio 5.2:1; the mean age of women was 66 years, of men 56 years. A malignant finding was confirmed in 4.6% of the operated patients. The most frequent finding was benign adenomatous colloid goitre (8.5%) and Hashimoto's thyroiditis (80.4%). Hyperthyroidism of the Graves-Basedow type (4.6%) and benign hyperthyroidism of the Plummer type (2.3%) were not frequent. Type of malignity: papillary carcinoma (3.45%) and follicular carcinoma (1.15%); medullary carcinoma, anaplastic carcinoma or lymphoma were not found. The most frequent surgical approach was cervical incision (Kocher) in 95.4%; it had to be supplemented by sternotomy only in 4.6% of the operated patients. As far as the extent of surgery is concerned, almost total thyroidectomy was performed in 60.9%, total lobectomy in 2.3%, subtotal thyroidectomy in 32.2% and subtotal lobectomy in 4.6% of the patients. 24.1% of the patients developed complications, only in 5.7% they were permanent. One female patient died (1.2%).

Conclusions: Retrosternal goitre accounted for cca 20% of patients operated on account of goitre. In cca 5% histology confirmed a malignant form (papillary and follicular carcinoma). Sternotomy was necessary only in less than 5% of the operated patients. The results of surgery are very good.