Substernal goiters: incidence, surgical approach, and complications in a tertiary care referral center.

BACKGROUND Surgery is the treatment of choice for substernal goiters, but there are still some controversies on their definition, the surgical approach, and the complications rate. We analyzed our experience in a tertiary care referral center. METHODS Among a series of 2263 patients who underwent thyroidectomy between 2004 and 2008, 355 patients with substernal goiter were identified. A control group of 355 patients with cervical goiters operated on during the same period was selected. The operative and pathological characteristics and the complications rate of the 2 groups were compared. RESULTS Only 2 patients (0.6%) required an extracervical approach (1 primary intrathoracic goiter and 1 recurrent carcinoma). No significant difference was found in terms of complications between the 2 groups. CONCLUSION The cervical approach can be safely performed in almost all the patients with substernal goiters. An extracervical procedure has very limited indications. Substernal goiter is not associated with increased complications rate.