Substernal goiters: Clinical presentation, diagnosis, and surgical management

Intrathoracic goiter [ITG] or substernal goiter [SSG] includes any thyroid enlargement in which over 50% portion of the thyroid permanently located under the thoracic inlet and lower pole of thyroid is not palpable with the neck in hyperextended position. Between Jan 1993 and July 2002, 334 patients underwent thyroidectomy for goiters in Rasht [North of Iran]. In this investiagation, initial presentations, surgical managements and complications of 32 patients with substernal goiter have been evaluated retrospectively. Results: There were 20 women and 12 men, with a mean age of 40 years [range 45-67 yrs]. Twenty-two patients presented with respiratory symptoms, two had dysphagia, four complained of hoarseness, and five patients were detected incidentally by CXR. Chest X-ray was the first step in diagnosis, and C. T Scan was the best imaging examination for diagnosis. Isotope scanning was helpful only in five patients. Twenty-one patients were operated with the collar incision, seven with collar incision, and in some along with partially sternotomyfour and four patients were operated by median sternotomy. In 17 patients the goiters were in the right anterior mediastinum and in 14, in the left anterior mediastinum, in one patient goiter was seen in the hilum of the right lung. Pathologic reports were as follows: multinodular goiter in 22 patients papillary cell carcinoma in seven patients anaplastic carcinoma in one patient and lymphoma in one patient. Medullary cell carcinoma in one patient. There was no hospital mortality. Postoperative complications occured in five patients. This study recommends that intrathoracic goiter should be operated early under suitable conditions because of malignant transformation and other hemorrhagic or serious complications

[Evaluation of transhiatal esophagectomy for esophageal cancer]

Introduction: Esophageal cancer is an invasive tumor with a poor prognosis. Unfortunately, this malignant tumor has a considerable prevalence in north part of Iran, especially near the Caspian Sea. It is also an important cause of cancer-related mortality. Surgery is the most effective approach for cure and also is used for palliation. Transmittal esophagectomy is a popular method of resection with a low morbidity and mortality

Objective: We designed this study to document the clinic pathologic characteristics of patients undergoing this procedure for esophageal cancer and to determine the contributing factors survival of patients

Materials and Methods: This descriptive study was performed between 1993 and first half of 2003 on 162 patients in Rasht Razi hospital. Patients' medical records were surveyed regarding their age, sex, stage of dysphagia, complications of surgery, mortality, stage of cancer and level of survival. Data were analyzed by EPI-6 software

Results: There were 102 male and 60 female patients. The mean age of patients was 57 years. 29.1% of them were urban versus 70.9% who were rural. The most frequent presenting symptoms were dysphagia [100%]. The most common site of tumor was lower third of esophagus [56%] and cardia] 22%]. 47.1% of patients required tube thoracostomy after surgery.9.8% of patients were splenectomized because of splenic injury. Recurrent nerve damage was observed in 4% of patients. 18.4% of patient's required mechanical ventilation. Pneumonia, Mediastinitis and Chylothorax was observed in 10, 2 and 2% of patients respectively. 13% had anastomosis leak in neck, which was managed conservatively. 83.1% of patients, were discharged from hospital in two weeks. The mean duration of hospital stay was 9.94 +/- 4.14 days. 14% of patients expired during first month of hospitalization. Survival in 1,2,3,4 and 5 years were 80%, 50%, 40%, 30% and 20% respectively

Conclusion: In this study mortality and morbidity were comparable with previous studies. On the other hand there wasn't any significant difference between results of this procedure and transthoracic approach that is used in other centers. Therefore it is recommended that transhiatal esophagectomy with appropriate selection of patients is the procedure of choice for curative and palliative means