Surgical management of substernal goiter

Purpose: We describe the clinical results and complications associated with differ ent surgical approaches to the treatment of substernal goiter. Methods: We retrospectively reviewed the medical records of 56 patients tre ated for substernal goiter from 1983 through 1999. Eight had undergone prev ious thyroidectomy. Posterior mediastinal goiter was diagnosed in eight pat ients, hyperthyroidism in seven, acute respiratory: failure in three, and s uperior vena cava syndrome in two. All but one of the patients underwent th yroidectomy. Results: Thyroid scan revealed that 88% of patients had substernal goiter. A cervical incision alone was used in 46 of 55 patients. Nine patients unde rwent thyroidectomy via a thoracic approach. Both lobes were resected in 16 patients. Two deaths occurred: one patient suffered a stroke and another p atient developed pneumonia after surgery. The most frequent complication wa s recurrent laryngeal nerve injury, followed by removal of a normal parathy roid gland and pneumonia. Multinodular goiter occurred in 52 patients. Rese cted goiter with occult malignancy was found in three patients, two, of who m underwent lobectomy only. These three patients had survived at 5, 7, and 11 years postoperatively, respectively. All patients with tracheal lumen na rrowing showed a normal sized tracheal lumen 2 to 3 months postoperatively. Conclusion: Our data indicate that the presence of a substernal goiter shou ld be considered an indication for resection based on risk of acute respira tory distress, risk of malignancy, and lower surgical morbidity. Most secon dary substernal goiters can be simply resected through cervical incision an d curation.