Surgical aspects of 175 mediastinal goiters.

OBJECTIVE: Clinical picture and surgical management of 175 mediastinal goiters are discussed in this retrospective study.

METHOD: Between 1979 and 1996, 175 patients with intrathoracic goiters were operated on at the Thoracic Surgical Clinic in Budapest. The majority of the goiters were cervicomediastinal (n = 138, 79%), past the level of aortic arch, and the others were complete aberrant lesions (n = 37, 21 %). Of the patients, 40% (n = 70) were symptom-free, in the others the clinical picture was dominated by compressive symptoms, among them, in five instances, the initial false, long-lasting diagnosis was bronchial asthma and, in four cases, vena cava superior syndrome caused by advanced inoperable malignancy. Twenty-two percent of patients (n = 39) were operated on previously for cervical struma. Eleven percent (n = 19) of the patients had hyperthyroid symptoms. In 124 cases the goiters were located in the anterior mediastinum. The majority (n = 96) of cervicomediastinal goiters (n = 138) could be removed through a cervical access, in the others an additional sternotomy (n = 31), or anterior thoracotomy (n = 11) were necessary. For resection of complete intrathoracic goiters (n = 37) standard thoracotomy (n = 30) or median sternotomy (n = 7) were used guided by retrotracheal or substernal position.

RESULTS: Hospital mortality was 1.1%. Minor complications occurred in 46 cases (26%) and laryngeal nerve palsy in 14 patients (8%). Tracheomalatia developed in 18 patients (10%) which were mainly solved by tracheal intubation for 4-6 days. Ninety-four percent (n = 165) of the lesions proved to be diffuse colloid or adenomatous goiters by histology and 10 were (mostly follicular type) carcinomas.

CONCLUSIONS: Unrecognized mediastinal goiters can produce asthma like symptoms, which may lead to late or misdiagnosis and deficient treatment. Once the diagnosis and exact extent of mediastinal goiter is established, multimodal surgical approaches are indicated for its safe removal - before occurrence of compressive symptoms.