SURGICAL OUTCOMES FOR THE TREATMENT OF RETROSTERNAL GOITERS: AN INTERNATIONAL, MULTICENTRIC STUDY

AUTHORS:
F. Medas (Cagliari, Italy) , F. Cappellacci (Cagliari, Italy) , G.L. Canu (Cagliari, Italy) , L. Rossi (Pisa, Italy) , M.S. Demarchi (Geneva, Switzerland) , G. Di Filippo (Verona, Italy) , P. Brazzarola (Verona, Italy) , G. Materazzi (Pisa, Italy) , P.G. Calò (Cagliari, Italy)
Background:
Surgery for retrosternal goiter is challenging, may require a multidisciplinary approach, and is traditionally associated to an increased occurrence of postoperative complications.
Methods:
Our retrospective multicentric study compared surgical outcomes of patients who had undergone retrosternal goiter vs. cervical goiter.
Results:
4467 patients, of which 276 (6.1%) with retrosternal goiter, from 4 high-volume thyroid centers were included in the study. We found a significantly increased occurrence of postoperative complications in patients with retrosternal goiter. Particularly, we found an increased occurrence of transient hypoparathyroidism (19.9% vs 9.4%; p < 0.001), permanent hypoparathyroidism (3.3% vs 1.6%; p = 0.035), bilateral recurrent laryngeal nerve injury (RLNI) (1.1% vs 0.1%; p = 0.015), permanent RLNI (1.4% vs 0.4 %; p = 0.037), and wound infection (1.4 % vs 0.2 %; p = 0.006).
Conclusions:
Thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons. Referral of these patients to high-volume thyroid centers is advisable. Intraoperative nerve monitoring (IONM), with possible two-stage operation, seems mandatory.