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Preoperative risk factors in total thyroidectomy of substernal goiter

The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter. The aim of this study was to...

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Autores principales: Bove, Aldo, Di Renzo, Raffaella Maria, D’Urbano, Gauro, Bellobono, Manuela, Addetta, Vincenzo D’, Lapergola, Alfonso, Bongarzoni, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135003/
https://www.ncbi.nlm.nih.gov/pubmed/27932888
http://dx.doi.org/10.2147/TCRM.S110464
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author Bove, Aldo
Di Renzo, Raffaella Maria
D’Urbano, Gauro
Bellobono, Manuela
Addetta, Vincenzo D’
Lapergola, Alfonso
Bongarzoni, Giuseppe
author_facet Bove, Aldo
Di Renzo, Raffaella Maria
D’Urbano, Gauro
Bellobono, Manuela
Addetta, Vincenzo D’
Lapergola, Alfonso
Bongarzoni, Giuseppe
author_sort Bove, Aldo
collection PubMed
description The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter. The aim of this study was to evaluate the preoperative risk factors associated with postoperative complications. From 2002 to 2014, 142 (8.5%; 98 women and 44 men) of the 1690 patients who underwent TT had a SG. We retrospectively evaluated the following parameters: sex, age, histology, pre- and retrovascular position, recurrence, and extension beyond the carina. These parameters were then related to the postoperative complications: seroma/hematoma, transient and permanent hypocalcemia, transient and permanent laryngeal nerve palsy, and the length of surgery. The results were further compared with a control group of 120 patients operated on in the same period with TT for cervical goiter. All but two procedures were terminated via cervicotomy, where partial sternotomies were required. No perioperative mortality was observed. Results of the statistical analysis (Student’s t-test and Fisher’s exact test) indicated an association between recurrence and extension beyond the carina with all postoperative complications. The group that underwent TT of SG showed a statistically significant higher risk for transient hypocalcemia (relative risk =1.767 with 95% confidence interval: 1.131–2.7605, P=0.0124, and need to treat =7.1) and a trend toward significance for transient recurrent laryngeal nerve palsy (relative risk =6.7806 with 95% confidence interval: 0.8577–53.2898, P=0.0696, and need to treat =20.8) compared to the group that underwent TT of cervical goiter. TT is the procedure to perform in SG even if the incidence of complications is higher than for cervical goiters. The major risk factors associated with postoperative complications are recurrence and extension beyond the carina. In the presence of these factors, greater care should be taken.
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spelling pubmed-51350032016-12-08 Preoperative risk factors in total thyroidectomy of substernal goiter Bove, Aldo Di Renzo, Raffaella Maria D’Urbano, Gauro Bellobono, Manuela Addetta, Vincenzo D’ Lapergola, Alfonso Bongarzoni, Giuseppe Ther Clin Risk Manag Original Research The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter. The aim of this study was to evaluate the preoperative risk factors associated with postoperative complications. From 2002 to 2014, 142 (8.5%; 98 women and 44 men) of the 1690 patients who underwent TT had a SG. We retrospectively evaluated the following parameters: sex, age, histology, pre- and retrovascular position, recurrence, and extension beyond the carina. These parameters were then related to the postoperative complications: seroma/hematoma, transient and permanent hypocalcemia, transient and permanent laryngeal nerve palsy, and the length of surgery. The results were further compared with a control group of 120 patients operated on in the same period with TT for cervical goiter. All but two procedures were terminated via cervicotomy, where partial sternotomies were required. No perioperative mortality was observed. Results of the statistical analysis (Student’s t-test and Fisher’s exact test) indicated an association between recurrence and extension beyond the carina with all postoperative complications. The group that underwent TT of SG showed a statistically significant higher risk for transient hypocalcemia (relative risk =1.767 with 95% confidence interval: 1.131–2.7605, P=0.0124, and need to treat =7.1) and a trend toward significance for transient recurrent laryngeal nerve palsy (relative risk =6.7806 with 95% confidence interval: 0.8577–53.2898, P=0.0696, and need to treat =20.8) compared to the group that underwent TT of cervical goiter. TT is the procedure to perform in SG even if the incidence of complications is higher than for cervical goiters. The major risk factors associated with postoperative complications are recurrence and extension beyond the carina. In the presence of these factors, greater care should be taken. Dove Medical Press 2016-11-28 /pmc/articles/PMC5135003/ /pubmed/27932888 http://dx.doi.org/10.2147/TCRM.S110464 Text en © 2016 Bove et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Bove, Aldo
Di Renzo, Raffaella Maria
D’Urbano, Gauro
Bellobono, Manuela
Addetta, Vincenzo D’
Lapergola, Alfonso
Bongarzoni, Giuseppe
Preoperative risk factors in total thyroidectomy of substernal goiter
title Preoperative risk factors in total thyroidectomy of substernal goiter
title_full Preoperative risk factors in total thyroidectomy of substernal goiter
title_fullStr Preoperative risk factors in total thyroidectomy of substernal goiter
title_full_unstemmed Preoperative risk factors in total thyroidectomy of substernal goiter
title_short Preoperative risk factors in total thyroidectomy of substernal goiter
title_sort preoperative risk factors in total thyroidectomy of substernal goiter
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135003/
https://www.ncbi.nlm.nih.gov/pubmed/27932888
http://dx.doi.org/10.2147/TCRM.S110464
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