Airway management in retrosternal goiter surgery: a five-year single-center retrospective observational study in a low-resource setting

Abstract Background Retrosternal goiter can cause tracheal deviation, airway compression, and recurrent laryngeal nerve dysfunction, posing challenges for perioperative airway management. Evidence guiding airway management strategies is largely derived from high-resource settings, with limited data from low- and middle-income countries. Objectives To evaluate airway management strategies and perioperative outcomes in patients undergoing retrosternal goiter surgery in Vietnam. Materials and methods We retrospectively reviewed 40 consecutive patients who underwent resection of retrosternal goiter between 2021 and 2025. Preoperative airway assessment combined symptom evaluation, bedside airway examination and cervicothoracic computed tomography, and airway management followed a stepwise multidisciplinary institutional approach in which the tracheal tube was downsized according to the degree of narrowing and adequate mask ventilation was confirmed before neuromuscular blockade. Data included preoperative clinical presentation, imaging, laryngoscopy and/or bronchoscopy, intraoperative anesthetic and surgical techniques, and postoperative complications. The primary outcome was successful endotracheal intubation. Secondary outcomes included airway-related and perioperative complications, post-anesthesia care unit time, and hospital length of stay. Results The median age was 62.0 years (interquartile range [IQR] 52.3–68.3), and 37.5% of patients were American Society of Anesthesiologists (ASA) physical status III. Nearly half of the patients were asymptomatic, while dyspnea was the most common presenting symptom. Radiological airway abnormalities were frequent, with tracheal compression observed in 97.5% of cases. Endotracheal intubation was successful in all patients (100%), predominantly using direct laryngoscopy (80%), with limited use of advanced airway techniques and no requirement for rescue airway procedures. Neuromuscular blockade was administered in 95% of cases without adverse events. No episodes of perioperative airway collapse or hemodynamic instability were observed. Postoperative complications occurred in 27.5% of patients and were predominantly mild, mainly related to recurrent laryngeal nerve dysfunction and hypoparathyroidism, while airway-related complications were rare. Conclusions In our setting, tracheal intubation was achieved in all patients and no rescue airway procedures were required. This safety profile was observed in a low-resource center without routine recourse to advanced airway techniques, and is hypothesis-generating pending prospective validation.