XXXX : when is a sternotomy required?

@entity1 @entity13209 @entity190 @entity5651
BACKGROUND: Sternotomy for @entity13209 ( @entity13209 ) is associated with greater morbidity than a cervical approach to thyroidectomy. We sought to identify predictors for sternotomy as a surgical approach for the removal of @entity13209 and analyzed the preoperative and postoperative characteristics of @entity1 with @entity13209 compared with those with large goiters contained entirely within the neck or a cervical @entity5651 . METHODS: A retrospective review of a surgical database was performed. We included @entity1 with large (>100  g) thyroids or @entity13209 , regardless of size. Between 1995 and 2013, 220 @entity1 met these criteria. Comparisons were made between @entity1 who had an @entity13209 and @entity1 who had a cervical @entity5651 with particular focus on those who required sternotomy. RESULTS: Of the 220 @entity1 , 127 @entity1 (58%) had @entity13209 , of whom 7 (5.5%) required sternotomy. All @entity1 who underwent sternotomy underwent preoperative computed tomography scanning and were more likely to have preoperative symptoms of chest pressure and voice complaints and have extension of the thyroid gland below the aortic arch. Sternotomy took an average of 2  hours longer than a cervical incision, was associated with significantly more @entity190 (600 versus 190  mL, P  =  0.04), and a longer length of stay (3.1 versus 1.8  d, P  =  0.03) than cervical thyroidectomy. CONCLUSIONS: Sternotomy for @entity13209 is rare. All @entity1 necessitating sternotomy had extension below the aortic arch and were more likely to present complaining of chest pressure and voice issues.
