Intrathoracic goitrescomparative study of the transcervical approach versus the combined cervicothoracic approach /

Resumen

Introduction. MNGs with intrathoracic extension often present with compressive symptoms and pose specific management challenges requiring specialised care by experienced surgical teams. Most ITG can be accessed by a TCA and only between 5 and 15% will require an ECA. Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. Aim. The aim of this study is to evaluate, analyse and compare the outcomes of patients undergoing surgery for ITG by the two main approaches. Material and Methods. An ambispective study of 237 patients undergoing surgery for ITG was undertaken. 27 patients underwent a combined cervical and midline sternotomy and 2 underwent a combined cervical and right lateral thoracotomy and the rest by a TC approach. Data on clinical presentation, investigations, complications and outcomes was collected prospectively and analysed. Results. The rate of malignancy in ITG was 8.01% with a rate of occult malignancy of 0.46%. The USS FNA had poor sensitivity (33%) but high specificity (93.3%) to exclude cancer. The risk of sternotomy was 12.2% and the extension BAA (p<0.001), iceberg shape (p<0.001) and reo-operation (p<0.001) were the best predictors of needing an ECA. The risk of RLNP and hypocalcaemia are higher in ECA (p<0.003 and p<0.002). The risk of tracheomalacia was 1.6% and the risk of tracheostomy was 2.5%. The median LOS in TCA was 3 days and 6 days in the ECA (p<0.0001) Conclusions. Surgery for ITG is challenging. It requires accurate evaluation and a multidisciplinary approach by specialised teams. Despite the nature and anatomical complexities of these goitres most of them can be excised via a TCA. The rate of complications is relatively low but higher in patients undergoing ECA.