Cervico-mediastinal Thyroid Masses - Our Experience

Introduction: Over the last decades, several definitions andclassifications of cervico-mediastinal goiters and thyroidmasses have been proposed. We analyze and discuss theclinical presentation, the diagnostic procedures and thesurgical technique in relation to post-operative complicationsand results in cervico-mediastinal thyroid masses admitted inour Clinic of Thoracic Surgery over a period of 22 years (1991-2012). Methods: We reviewed 130 patients who underwent surgery forretrosternal thyroid masses, 77 (59.23%) women and 53(40.77%) men. Mean age was of 53 years. Shortness of breathwas observed in 71 (54.61%) patients as the mostfrequent preoperative symptom. Cervico-thoracic CT scanreveales the existence of a cervico-mediastinal mass and canappreciate the degree of intrathoracic progression, trachealcompression and dislocation, as well as the relations withother anatomical structures of the visceral mediastinum. All130 patients were prepared for a thoracic approach, majority ofthe cases were operated by Prof. T. Horvat. The surgicalprocedure was performed by cervical approach only in most ofthe cases (106 cases) (Kocher type cervicotomy in 63 cases andHorvat type “en-Y” cervicotomy in 43 cases). We used a bipolarapproach for large cervico-thoracic masses: cervicotomyand partial upper sternotomy in 20 cases, cervicotomy and fullsternotomy in 3 cases, cervicotomy and right axillary thoracotomyin one case.Results: The removal of the thyroid mass and decompression ofthe trachea have been achieved in all cases. Postoperativeresults were very satisfactory, with absence of respiratory distressand with normal function of the vocal cords. No postoperativemortality was encountered.Conclusion: The presence of a cervico-mediastinal thyroidmass with or without respiratory distress requires a surgicalexcision as the only treatment option. The surgical procedurerepresented a milestone for both anesthesiologist (difficultintubation in some cases of large goiters) and thoracic surgeon.Thyroid masses extending to the mediastinum can be excisedsuccessfully by cervical incision. Bipolar approach has anexcellent outcome, achieving a safe resection, especially inlarge thyroid masses extending to the mediastinum with closerelations to mediastinal structures.

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