Il gozzo cervico-mediastinico. Esperienza personale

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COD: 517-522 Categorie: ,

Carmelo Sciumè, Girolamo Geraci, Franco Pisello, Francesco Li Volsi, Tiziana Facella, Giuseppe Modica

Ann. Ital. Chir., 2005; 76: 517-522

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INTRODUCTION: Aim of the study is to discuss the diagnostic and therapeutic problems of substernal goiter (SG).
MATERIALS AND METHODS: The Authors retrospectively analyzed 12 patients (3.1%) with substernal goiters among 379
patients undergoing surgical treatment for thyroid diseases from January 2000 to 2005, and evaluated the clinical data,
preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications.
RESULTS: The most common symptoms were a cervical mass (100%) and dyspnea (16%), but 50% of the patients were
asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 100% of the patients. The AA
performed total thyroidectomy and operated through a cervical incision in all the patients. There was operative mortality
(1 case: = 8%), 2 (16%) patients suffered temporary hypoparathyroidism; no patients suffered transient vocal cord
paralysis. Malignancy was diagnosed by histopathological examination in 2 patients (16%).
CONCLUSIONS: The presence of a substernal goiter is considerd as a sole indication for surgery. Surgical treatment of SG
requires a diagnosis that exactly defines the extent of the lesion. A correct choice of surgical access and scrupulous operating
technique are likewise of paramount importance to reduce the risk of severe compressive complications. Most retrosternal
goiters can be resected through an entirely cervical approach with a low complication rate. On rare occasions a
median sternotomy or a sternal split will be required to permit a safe and complete thyroidectomy.