Objective

Thyroidectomy is usually carried out through a cervical incision by ENT surgeons. Patients with retrosternal extension usually require extra-cervical approach and hence expertise of thoracic surgeons. This has traditionally been sternotomy or thoracotomy; we also offer video-assisted thoracoscopy as an approach. We devised a joint pathway with our ENT colleagues to streamline management of patients with retrosternal goitre in our region. We report the outcome of this multidisciplinary approach.

Methods

Pathway: Patients with large retrosternal goitres with tracheal compression/deviation will be assessed by thoracic surgeon and ENT surgeons and offered joint procedure in our regional centre. The patients were operated in the thoracic unit with a thoracic anaesthetist. Eighteen patients with retrosternal goitre were referred to our institution between 2012-15. We analysed the outcome of patients who underwent surgery for retrosternal goitre from a prospective database.

Results

Mean age at surgery was 66 years ± 12 SD. Eight patients underwent cervical approach only, 5 had Right VATS and cervical and 4 underwent sternotomy. Two lesions were malignant with R0 resection and 16 were benign. Mean vertical height was 100 mm ± 3.7 SD. Mean weight was 128g ± 79 SD. One patient who had right VATS and cervical incision required median sternotomy and re-exploration for bleeding from the inferior thyroid vein. There was no mortality at 30 days. Mean stay was 4.5days ± 2 SD.

Conclusion

Multidisciplinary management of patients with retrosternal thyroid is safe, effective and reliable. Presence of both specialities covers all eventualities in these cases. Thoracic anaesthetists and thoracic HDU input is crucial in ensuring safe recovery from surgery and a timely discharge.