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01.08.2011 | Endocrine Tumors | Ausgabe 8/2011

Annals of Surgical Oncology 8/2011

Does Mediastinal Extension of the Goiter Increase Morbidity of Total Thyroidectomy? A Multicenter Study of 19,662 Patients

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 8/2011
Autoren:
MD Mario Testini, MD Angela Gurrado, MD Nicola Avenia, MD Rocco Bellantone, MD, PhD Antonio Biondi, MD Paolo Brazzarola, MD, PhD Filippo Calzolari, MD, PhD Giuseppe Cavallaro, MD Giorgio De Toma, PhD Pietro Guida, MD, PhD Germana Lissidini, MD Michele Loizzi, MD Celestino Pio Lombardi, MD Giuseppe Piccinni, MD, PhD Piero Portincasa, MD Lodovico Rosato, MD Nora Sartori, MD Chiara Zugni, MD Francesco Basile
Wichtige Hinweise
This paper was presented in poster format at the Annual American Association of Endocrine Surgeons Meeting; April 18–20, 2010, Pittsburgh, PA.

Abstract

Purpose

To compare the outcome in patients with cervical goiters and cervicomediastinal goiters (CMGs) undergoing total thyroidectomy using the cervical or extracervical approach.

Methods

This was a retrospective study conducted at six academic departments of general surgery and one endocrine-surgical unit in Italy. The study population consisted of 19,662 patients undergoing total thyroidectomy between 1999 and 2008, of whom 18,607 had cervical goiter (group A) and 1055 had CMG treated using a cervical approach (group B, n = 986) or manubriotomy (group C, n = 69). The main parameters of interest were symptoms, gender, age, operative time, duration of drain, length of hospital stay, malignancy and outcome.

Results

A split-sternal approach was required in 6.5% of cases of CMG. Malignancy was significantly more frequent in group B (22.4%) and group C (36.2%) versus group A (10.4%; both P < .001), and in group C versus group B (P = .009). Overall morbidity was significantly higher in groups B + C (35%), B (34.4%) and C (53.5%) versus group A (23.7%; P < .001). Statistically significant increases for group B + C versus group A were observed for transient hypocalcemia, permanent hypocalcemia, transient recurrent laryngeal nerve (RLN) palsies, permanent RLN palsies, phrenic nerve palsy, seroma/hematoma, and complications classified as other. With the exception of transient bilateral RLN palsy, all of these significant differences between group B + C versus group A were also observed for group B versus group A.

Conclusions

Symptoms, malignancy, overall morbidity, hypoparathyroidism, RLN palsy and hematoma are increased in cases of substernal goiter.

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