Cervico-mediastinal extension of thyroid cancer

A surgical series of 30 cervico-mediastinal thyroid cancer patients operate d on has been retrospectively reviewed. Results were compared with those ob tained in patients operated on for benign cervico-mediastinal goiter and th yroid cancer confined to cervical region. Of 4688 thyroidectomies performed , 30 patients were operated on for thyroid carcinoma with cervicomediastina l extension. There were 15 males and 15 females. The mean age was 67 years (range, 21-86 years). Patients with cervico-mediastinal cancer were signifi cantly older than patients with benign cervico-mediastinal goiter (P < 0.00 01). Time between onset of first symptoms and surgery was significantly lon ger in patients with cervico-mediastinal cancer than in those with benign c ervico-mediastinal goiter (P < 0.0001) and cervical thyroid cancer. Signs a nd symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dyspha gia in 9 (30%), dysphonia in 2 (7%), and venous stasis in 1 (3%). None of t he patients was asymptomatic. Total thyroidectomy with functional lymphecto my was performed in 16 cases. Seven of these patients were operated on in 2 stages. In 8 cases the operation was a debulking procedure, and in 6 it wa s a near-total thyroidectomy. Sternotomy was performed in two cases. A diff erentiated thyroid cancer was found in 21 patients (70%), medullary in 5 (1 7%) and undifferentiated in 4 (13%). The incidence of medullary carcinoma w as significantly higher compared with cervical cancer (P < 0.008). Postoper ative complications were higher than those occurring in benign cervico-medi astinal goiter and similar to those occurring in cervical cancer. The actua rial survival was similar to that of cervical cancer matched for age and se x. This analysis shows that the longer clinical history of goiter is relate d to its endothoracic development and its neoplastic transformation. This f inding should further encourage surgeons to treat any cervico-mediastinal g oiter as promptly as possible.