OPTIMIZING SURGICAL STRATEGIES FOR GIANT AND RETROSTERNAL GOITERS: RESULTS FROM A FIVE-YEAR INSTITUTIONAL STUDY

Abstract

To systematically evaluate and optimize the surgical management of giant and substernal goiters, a comprehensive clinical analysis of 147 patients (mean age 54.2 years) treated between 2019 and 2024 was conducted. Utilizing Multi-Slice Computed Tomography (MSCT), mediastinal extension was anatomically categorized into Grades I (51.0%), II (35.4%), and III (13.6%). The primary surgical strategy heavily favored a standard cervical approach, allowing for successful total excision via a Kocher collar incision alone in 87.1% (n=128) of the cohort. However, 10.2% (n=15) of patients required conversion to median sternotomy due to complex anatomical anchoring or "hourglass" morphological configurations, and 2.7% (n=4) necessitated lateral thoracotomy for deep posterior descent. Post-operative outcomes demonstrated a high safety profile, with transient hypocalcemia (9.5%), transient recurrent laryngeal nerve palsy (5.4%), and structural tracheomalacia managed effectively via prolonged intubation (2.0%), alongside a 0% operative mortality rate. Ultimately, while the vast majority of substernal masses can be extracted via a cervical incision, maintaining strict criteria for thoracic access escalation is essential for deep extensions to ensure immediate vascular control and safeguard the compromised airway.