Excision of substernal goiter via cervical approach: a clinical analysis of 57 cases
Objective: To investigate the indications and the surgical techniques for excision of substernal goiter via cervical approach. Methods: The clinical data and surgical results of 57 patients with substernal goiters undergoing surgical excision through cervical approach from January 2013 to September 2016 were retrospectively analyzed. Results: Of the 57 patients (including 2 cases of ectopic goiters), 22 cases had no obvious clinical symptoms and the other 35 cases presented with compression symptoms such as dyspnea, dysphagia and hoarseness; the lesions were classified according to Randolph’s criteria as type I in 34 cases, type IIA in 16 cases, type IIB in 5 cases and type III in 2 cases, and based on CT classification as grade 1 in 30 cases, grade 2 in 18 cases and grade 3 in 9 cases, respectively. Cervical approach thyroidectomy was performed in all these patients, including repeat thyroid surgery in 6 cases (10.5%). There were benign diseases in 49 patients and differentiated thyroid cancers in 8 patients as evidenced by pathological findings. Postoperative complications included temporary vocal cord paralysis in one case (1.8%) and temporary hypocalcemia in 5 cases (8.8%). Conclusion: The majority of substernal goiters can be safely excised through cervical approach after thorough preoperative assessment. Excellent surgical skills, operation by experienced surgeons and readily accessible thoracotomy set are the premises and critical to surgical success.