Surgical outcomes and experience of the cervical approach in retrosternal goiter: A single-center retrospective study in Vietnam

The choice of surgical approach for substernal goiter remains a subject of ongoing debate. While the cervical approach is common, alternatives like partial sternotomy or Video-Assisted Thoracic Surgery (VATS) are essential for primary (ectopic) mediastinal goiters. This study aims to share our single-center experience and surgical outcomes in the management of substernal goiters through a cervical approach. A retrospective cross-sectional descriptive study was conducted on patients surgically treated for substernal goiter at the National Hospital of Endocrinology between 2020 and 2024. A total of 133 cases were included in the study. The mean age was 63.14 ± 8.66 years, with females accounting for 83%. According to the Huins-Mercante classification, on the coronal plane: 92.5% were Grade I, 6% Grade II, and 1.5% Grade III; on the sagittal plane: 70% were Type A, 30% Type B, and 0% Type C. All cases were successfully performed via a cervical approach. The mean operative time was 50.2 ± 15.1 min. Complications included: temporary hypoparathyroidism (6%), permanent hypoparathyroidism (0.8%), temporary hoarseness (3.8%), permanent hoarseness (0.8%), and 3 cases of postoperative bleeding (2.3%). The mean hospital stay was 6.84 ± 3.64 days. The malignancy rate was 2.2%. Cervical approach should be the gold standard technique for exploring substernal goiter with a digital dissection. Sternotomy is related to a higher rate of complications, so it should be performed only in selected cases such as extensive invasion into surrounding structures or conical goiters that cannot pass through the thoracic inlet. Even deep Grade III extensions can be managed via the cervical approach by experienced surgeons, provided there is no extensive invasion. • All 133 cases were successfully managed via cervical approach with zero sternotomy reported in this study. • Experienced surgeon can manage substernal goiter via a cervical approach even for extension reaching the aortic arch. • A cervical-only approach is hazardous for invasive goiters and conical goiter that cannot pass through the thoracic inlet.