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Updates in Surgery
Published in: Updates in Surgery 4/2021

01-08-2021 | Sternotomy | Original Article

Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study

Authors: S. Van Slycke, A.-S. Simons, K. Van Den Heede, P. Van Crombrugge, K. Tournoy, P. Simons, H. Vermeersch, N. Brusselaers

Published in: Updates in Surgery | Issue 4/2021

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Abstract

Objective

Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear.
This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy.

Methods

In a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500).

Results

An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%).

Conclusion

In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy.

Level of evidence

IV
Appendix
Available only for authorised users
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Metadata
Title
Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study
Authors
S. Van Slycke
A.-S. Simons
K. Van Den Heede
P. Van Crombrugge
K. Tournoy
P. Simons
H. Vermeersch
N. Brusselaers
Publication date
01-08-2021
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 4/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-021-01027-1

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