Surgical management of cervico-mediastinal goiters: Our experience and review of the literature
Autor: | Paolo Laperuta, L. Valvano, Mario Vitale, Filomena Napolitano, V.G. Di Crescenzo, Alessandro Vatrella, Pio Zeppa, G. De Rosa, Bruno Amato |
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Přispěvatelé: | Di Crescenzo, V, Vitale, M., Valvano, L., Napolitano, F., Vatrella, A., Zeppa, Pio, DE ROSA, Gaetano, Amato, B., Laperuta, P. |
Rok vydání: | 2015 |
Předmět: |
Male
Goiter endocrine system diseases medicine.medical_treatment Intrathoracic thyroid mass 030230 surgery Thyroiditis 0302 clinical medicine Postoperative Complications Robotic Surgical Procedures Postoperative Period Thyroid Mediastinum General Medicine Middle Aged medicine.anatomical_structure Cardiothoracic surgery 030220 oncology & carcinogenesis Goiter Substernal Thyroidectomy Female Vocal Cord Paralysis Adult endocrine system medicine.medical_specialty Hypoparathyroidism Choristoma 03 medical and health sciences Intrathoracic thyroid ma medicine Humans Thyroid Neoplasms Total thyroidectomy Cervico-mediastinal goiter Cervicosternotomy Cervicotomy Aged business.industry Carcinoma medicine.disease Sternotomy Surgery Median sternotomy business Neck |
Zdroj: | International journal of surgery (London, England). 28 |
ISSN: | 1743-9159 |
Popis: | Aim We analyze and discuss the clinical presentation, the diagnostic procedures and the surgical technique in relation to post-operative complications and results in cervico-mediastinal thyroid masses admitted in Thoracic Surgery Unit of AOU Second University of Naples from 1991 to 2006 and in Thoracic Surgery Unit of AOU "S. Giovanni di Dio & Ruggi D'Aragona" of Salerno over a period of 3 years (2011–2014). Methods We reviewed 97 patients who underwent surgical treatment for cervico-mediastinal goiters. 47 patients (49.2%) had cervico-mediastinal goiter, 40 patients (40%) had mediastino-cervical goiter and 10 patients (10.8%) had mediastinal goiter. 73 cases were prevascular goiters and 24 were retrovascular goiters. We performed total thyroidectomy in 40 patients, subtotal thyroidectomy in 46 patients and in 11 cases the resection of residual goiter. In 75 patients we used only a cervical approach, in 21 patients the cervical incision was combined with median sternotomy and in 1 patient with transverse sternotomy. Results Three patients (3.1%) died in the postoperative period (2 cardio-respiratory failure and 1 pulmonary embolism). The histologic study revelead 8 (7.7%) carcinomas. Postoperative complications were: dyspnea in 9 cases (10.7%), transient vocal cord paralysis in 6 patients (9.2%), temporary hypoparathyroidism in 9 patients (9.2%) and kidney failure in 1 case (0.9%). Conclusions The presence of a cervico-mediastinal thyroid mass with or without respiratory distress requires a surgical excision as the only treatment option. Thyroid masses extending to the mediastinum can be excised successfully by cervical incision. Bipolar approach (cervical incision and sternotomy) has an excellent outcome, achieving a safe resection, especially in large thyroid masses extending to the mediastinum with close relations to mediastinal structures and in some limited cases (carcinoma, thyroiditis, retrovascular goiter, ectopic goiter). Postoperative mortality and morbidity is very low, independent of surgical techniques. Other surgical approaches for excision of a Posterior Mediastinal Thyroid Goiter reported in literature are: VATS techniques to remove an ectopic intrathoracic goiter, robot-assisted technique for the removal of a substernal thyroid goiter, with extension into the posterior mediastinum. |
Databáze: | OpenAIRE |
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