Surgical management of intrathoracic goitres

Background Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist rega...

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Published in:European archives of oto-rhino-laryngology 2019-02, Vol.276 (2), p.305-314
Main Authors: Simó, Ricard, Nixon, Iain J., Vander Poorten, Vincent, Quer, Miquel, Shaha, Ashok R., Sanabria, Alvaro, Alvarez, Fernando Lopez, Angelos, Peter, Rinaldo, Alessandra, Ferlito, Alfio
Format: Article
Language:English
Subjects:
Anesthesia, Endotracheal
Goiter, Substernal - diagnostic imaging
Goiter, Substernal - surgery
Head and Neck Surgery
Humans
Hypocalcemia - etiology
Intraoperative Complications
Intraoperative Neurophysiological Monitoring
Intubation, Intratracheal
Medicine
Medicine & Public Health
Minimally Invasive Surgical Procedures
Neurosurgery
Otorhinolaryngology
Pneumothorax - etiology
Postoperative Complications
Recurrent Laryngeal Nerve Injuries
Review Article
Risk Assessment
Thyroidectomy - methods
Tomography, X-Ray Computed
Tracheomalacia - etiology
Tracheostomy
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Summary:Background Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. This paper reviews the recent literature on the management, outcomes and evidence-based treatment strategies of ITG. Methods We conducted a review of the literature on the evaluation, management and outcomes of surgery for ITGs. Results The incidence of cancer in the ITGs ranges between 4 and 20%. Multiplanar CT scanning offers the best preoperative evaluation and aids to determine the approach. Most ITG can be accessed by TCA and ECA are only needed in maximum 15% of cases. In experienced hands, the outcome of these surgeries is comparable to thyroid surgery for non-ITG. Conclusions Surgery for ITG is challenging. The experienced surgeon however, with few exceptions can address ITG via TCA, with outcomes comparable to those of uncomplicated thyroid surgery.
ISSN:0937-4477
1434-4726
DOI:10.1007/s00405-018-5213-z