Mediastinal goiter: twenty-eight years experience of a referral centre for endocrine surgery on 1721 patients.

Aim. Mediastinal goiter (MG) accounts for 5.8% of all mediastinal masses. Surgery is mainly indicated for compression symptoms and risk of malignancy. The most common symptoms are choking, dyspnoea, sleeping apnea and dysphagia. Total thyroidectomy via a cervical approach is the most used procedure. In selected cases a partial or complete median sternotomy or a thoracotomy are used. Aim of the study was the analysis of a large experience in the treatment of mediastinal goiter, debating its current topics. Methods. A retrospective analysis of twentyeight years on 1721 cases of MG in a referral centre for endocrine surgery was carried out. All patients underwent standard preoperative study and CT based surgical planning. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected cases via sternotomy or thoracotomy. Clinical records were examined. Results. Total thyroidectomy was performed in all cases. A cervical approach was used in almost 99% of patients. Significant shorter surgical time was observed for surgery via the cervical approach vs. sternotomy and thoracotomy. Benign struma was observed in 1463 patients and a carcinoma in 258. We observed postoperative bleeding in 0.5% of cases, permanent monolateral recurrent laryngeal nerve palsy occurred in 1.3%, bilateral palsy in 0.6%, transient and permanent hypoparathyroidism in 14% and 4.1% respectively. Conclusion. Total thyroidectomy via cervical approach is the gold standard of treatment for mediastinal goiter. It should be treated only in referral centre with adequate preoperative study and surgical skills to achieve complete cure with limited complications.