Sternotomy for thyroidectomy: five-cases surgical experience

Abstract Background Thyroidectomies requiring sternotomy represent a critical surgical challenge, particularly in resource-constrained settings where advanced thyroid disease often presents late. This case series highlights the necessity, outcomes, and inherent risks of sternotomy for thyroid malignancies with mediastinal extension or vascular compromise, providing evidence to guide surgical decision-making in similar environments. The study aims to: (1) describe indications for sternotomy in thyroidectomy, (2) analyze postoperative outcomes, and (3) propose a framework for patient selection in low-resource settings. Case presentation We analyzed five consecutive patients (3 males, 2 females; mean age 57 years) undergoing thyroidectomy with sternotomy between 2002 and 2023. All patients presented with compressive symptoms (dyspnea, dysphagia, or hoarseness), and imaging confirmed extension to the superior part of the anterior mediastinum (mean tumor size 9.2 cm). Indications for sternotomy included inferior margin control (60%), recurrent laryngeal nerve lymphadenopathy with thoracic infiltration (20%), and jugular vein thrombosis (unilateral, presenting with neck swelling and collateral veins) (20%). Postoperative complications occurred in 4 patients (80%), including pleural effusion (40%), pneumonia requiring bronchoscopy (20%), and one mortality (20%) due to mediastinitis (secondary to esophageal perforation, managed with debridement and antibiotics). Histopathology identified malignancy in 60% of cases (medullary, papillary, and follicular carcinomas). No recurrences were observed in malignant cases during follow-up (mean 24 months; range 6–40). Conclusions Sternotomy remains indispensable for managing thyroid malignancies extending beyond the thoracic inlet or involving major vasculature, despite significant morbidity risks. Key lessons include: (1) Multidisciplinary consensus is mandatory for sternotomy consideration, particularly for tumors with tracheal compression or vascular invasion; (2) The 20% mortality rate underscores the need for meticulous patient selection; (3) Centralized management may improve outcomes in low-resource settings. Study limitations include the small sample size and single-institution design.