Substernal goiters. Report of 212 cases.

Aim of the study: The aim of this retrospective study was to report the res ults of the surgical treatment in a series of 210 patients operated on for substernal goiters. Patients and method: From 1982 to 1996, 210 patients with substernal goiter s, including 80% of women, were operated on via a cervical approach in 208 cases, via a sternotomy in two cases. Two patients with operative contra-in dications were not operated on. Twenty-five were operated on for a substern al recurrence of a goiter. In 160 cases, extraction of the substernal porti on was easy. in 48 cases, removal of the substernal portion was facilitated by the discovery of the recurrent nerve at its entering into the larynx an d a downward dissection of the tracheal attachments of the lobe. The comple te dissection of the cervical portion made easier the ascension of the subs ternal portion even in very large substernal components. Results: Three papillary carcinomas were diagnosed. A transient laryngeal n erve palsy occurred in 7,2% of the patients and a transient hypoparathyroid ism in 13,4%, A definitive laryngeal nerve palsy occurred in 1,2% of the pa tients, and a persistant hypoparathyroidism in 2,1%. Of the 25 patients who underwent surgery for recurrence of a goiter, three (12%) developped a tra nsient laryngeal nerve palsy, one (4%) a permanent nerve palsy, four (20%) a transient hypoparathyroidism and one (4%) a persistent hypocalcemia. Conclusion: CT scan and MRI are the best explorations to evaluate intrathor acic extension of substernal goiters. Thyroidectomy was performed via a cer vical incision in 208 patients and via a sternotomy in two patients only. T he complete dissection of the cervical portion with discovery of the recurr ent nerve at its entering into the larynx, facilitates the ascension of the substernal portion even in very large substernal goiters. (C) 2000 Edition s scientifiques et medicales Elsevier SAS.