Abstract
Background: Retrosternal goiter (RSG) is a clinically important entity which may be encountered in 3-20% of thyroidectomy procedures, of which 5-15% require median sternotomy for safe resection. Unanticipated sternotomy may be associated with an increased operative time, blood loss and postoperative morbidity. Preoperative contrast-enhanced computed tomography (CECT) is an important tool for anatomical information but does not have any definitive criteria defined for prediction of sternotomy need from a CT point of view.
Objectives: To evaluate the association between preoperative CT findings and the requirement for sternotomy in patients undergoing surgery for retrosternal goiter.
Methods: This was a retrospective cohort study of 62 patients with retrosternal goiter (RSG), who were subjected to thyroidectomy from 2022-2024, at the Lady reading Hospital Peshawar,Pakistan. CECT images were reviewed for tracheal deviation/compression, vascular involvement and extension into the mediastinal spaces. Independent sternotomy predictors were determined using binary logistic regression.
Results: Of the 62 patients, 54 (87.1%) were managed through a cervical approach, while 8 (12.9%) required sternotomy. There was no statistically significant difference between tracheal deviation/compression or vascular involvement and sternotomy requirement (p=0.141 and p=0.258, respectively). Groups were comparable with regard to demographic characteristics.
Conclusion: In this regional cohort, common CT findings like compression of the trachea and vascular involvement were not individually associated with sternotomy. This provides an insight into the need for extensible, multiparametric, CT scoring system validated in resource-limited environments