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Results of surgical treatment in multinodular goiter with an intrathoracic component.

AbstractPURPOSE:
(1) To determine the clinical profile of intrathoracic multinodular goiter (IMG); (2) to evaluate the results of surgery, and (3) to analyze the incidence of malignancy and its evolution.
METHODS:
Two hundred and forty-seven operated cases of IMG were reviewed. These cases of IMG had all been diagnosed according to Eschapse's definition (>3cm below the sternal manubrium). The morbidity and postoperative evolution were analyzed. A comparative study was carried out on a group of 425 cases of nonintrathoracic goiter. We applied the chi(2) test, Student's t-test, and a logistical regression analysis.
RESULTS:
Intrathoracic MG occurs in patients over 60 years of age, with goiter which has a long evolution time (>12 years), and more than 60% are symptomatic. Oral tracheal intubation was difficult in 10% (n = 24) of the cases, and 7 required the use of a fibrobronchoscope. In 8 cases (3%) a thoracic approach was necessary. Morbidity occurred in 24% (n = 59), most notably 29 recurring lesions (12%), of which 2 were definitive (0.8%), and 31 hypoparathyroidisms (13%), of which 1 was definitive (0.4%). No significant difference was found in the postsurgical morbidity between the intrathoracic MG and the nonintrathoracic cases. Regarding the remission of the symptoms, the results were excellent. In 14 cases (5.7%) thyroid carcinoma was related with, most of these being papillary microcarcinoma. In 10 of the 49 cases of partial surgery (20%) a relapse of the goiter was observed.
CONCLUSIONS:
Intrathoracic MG is usually asymptomatic and it occurs in goiter with a long time of evolution. Surgery is a good therapeutic option given that the goiter can be removed via the neck, with low morbidity, a remission of the symptoms, malignancy is ruled out, and recurrence can be avoided if a total thyroidectomy is performed.
AuthorsAntonio Ríos, José M Rodríguez, Pedro J Galindo, Juan Torres, Manuel Canteras, María D Balsalobre, Pascual Parrilla
JournalSurgery today (Surg Today) Vol. 38 Issue 6 Pg. 487-94 ( 2008) ISSN: 0941-1291 [Print] Japan
PMID18516526 (Publication Type: Comparative Study, Journal Article)
Topics
  • Carcinoma, Papillary (complications)
  • Female
  • Goiter, Substernal (surgery)
  • Humans
  • Hypoparathyroidism (etiology)
  • Intubation, Intratracheal
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications
  • Recurrence
  • Thyroid Neoplasms (complications)
  • Thyroidectomy
  • Treatment Outcome

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