İntratorasik Guatrın Histopatolojik Özellikleri Karar Vermede Önemlidir

Öz

Amaç: Çalışmanın amacı, intratorasik guatrın çıkarılması için torasik yaklaşımlara duyulan ihtiyacı belirleyen faktörleri incelemektir. Gereç ve Yöntem: Bu retrospektif çalışma 2011-2018 yılları arasında gerçekleştirildi. Hastalar iki gruba ayrıldı; Grup A transservikal yaklaşımla ameliyat edilen hastalardan, Grup B transservikal ve torasik yaklaşımla ameliyat edilen hastalardan oluşuyordu. Bilgisayarlı tomografi incelemelerinde intratorasik guatrın uzunluğu, boyutu ve lokalizasyonu ölçüldü. Histopatolojik inceleme sonuçları kaydedildi. Bulgular: Grup A 268 hastadan, Grup B ise 17 hastadan oluşuyordu. Gruplar arasında nüks açısından istatistiksel olarak anlamlı fark vardı. Gruplar arasında bilgisayarlı tomografi, numune hacmi ve süperoinferior boyutunda guatr uzunluğu açısından istatistiksel olarak anlamlı bir fark yoktu. Torakotomi seçimi ile intratorasik guatrın lokalizasyonu arasında istatistiksel olarak anlamlı bir ilişki vardı. Torakotomi seçimi ile patolojik alt tipler arasında istatistiksel olarak anlamlı bir ilişki vardı. Sonuç: Torasik yaklaşımların gerekliliğini belirlemede guatrın boyutları önemli değilken; intratorasik guatrın çıkarılmasında nüks, lokalizasyon ve histopatolojik özelliklerin belirleyici olduğu bulundu.

Anahtar Kelimeler

• Intratorasik
• guatr
• torakotomi

Histopathological Features of Intrathoracic Goitre are Important in Decision Making

Öz

Aim: The aim of the study is examining the factors determining the need for thoracic approaches to remove an intrathoracic goitre. Material and Method: This retrospective study was conducted between 2011 and 2018. Patients were categorized into two groups; Group A consisted of patients who underwent surgery via the transcervical approach, and Group B consisted of patients who underwent surgery via the transcervical plus thoracic approaches. The extension, size, and localization of the intrathoracic goitre was measured on computed tomography scans. Histopathological examination results were recorded. Results: Group A was consisted of 268 patients, Group B was consisted of 17 patients. There was statistically significant difference in terms of recurrence between groups. There were no statistically significant difference for length of goitre in computed tomography, volume and superoinferior size of the specimen between groups. There was a statistically significant correlation between the choice of thoracotomy and the localization of the intrathoracic goitre. There was a statistically significant correlation between the choise of thoracotomy and pathological subtypes. Conclusion: While dimentions of the goitre were not important in determining the necessity of thoracic approaches; recurrence, localization, and histopathological features were found to be determinants in removing an intrathoracic goitre.

Anahtar Kelimeler

• Intrathoracic
• goitre
• thoracotomy

Kaynakça

1. 1-Vaiman M, Bekerman I, Basel J, Peer M. Surgical Approach to the Intrathoracic Goitre. Laryngoscope Investig Otolaryngol. 2018;(2):127-32. doi: 10.1002/lio2.146.
2. 2-Pata G, Casella C, Benvenuti M, Crea N, Di Betta E, Salerni B. ‘Ad hoc’ sternal-split safely replaces full sternotomy for thyroidectomy requiring thoracic access. Am Surg. 2010;76(11):1240-
3. 3- Rugiu MG, Piemonte M. Surgical approach to retrosternal goitre: do we still need sternotomy? Acta Otohinolaryngol Ital. 2009;29(6):331-8.
4. 4-Zhou J, He J, Wu J. Application of Video-Assisted Thyroidectomy for Cervicomediastinal Goitre. J Laparoendosc Adv Surg Tech. 2015;25(11):926-31. doi: 10.1089/lap.2015.0083.
5. 5- Topcu S, Liman ST, Canturk Z, et al. Necessity for additional incisions with the cervical collar incision to remove retrosternal goitres. Surg Today. 2008;38(12):1072-7. doi: 10.1007/s00595-008-3768-9.
6. 6- Machado NO, Grant CS, Sharma AK, Al Sabti HA, Kolidyan SV. Large posterior mediastinal retrosternal goitre managed by a transcervical and lateral thoracotomy approach. Gen Thorac Cardiovasc Surg. 2011;59(7):507-11. doi: 10.1007/s11748-010-0712-x.
7. 7- Cichon S, Anielski R, Konturek A, Baczynski M, Cichon W, Orlicki P. Surgical management of mediastinal goitre: risk factors for sternotomy. Langenbecks Arch Surg. 2008;393(5):751-7. doi:10.1007/s00423-008-0338-y.
8. 8-Sancho JJ, Kraimps JL, Sachez-Blanco JM, et al. Increased mortality and morbidity associated with thyroidectomy for intrathoracic goitres reaching the carina tracheae. Arch Surg. 2006;141(1):82-5.

9. 9- Casella C, Molfino S, Cappelli C, Salvoldi F, Benvenuti MR, Portolani N. Thyroiditis process as a predictive factor of sternotomy in the treatment of cervicomediastinal goitre. BMC Surgery. 2019,18(Suppl 1):20. https://doi.org/10.1186/s12893-019-0474-z
10. 10-Batori M, Chatelou E, Straniero A, et al. Substernal goiters. Eur Rev Med Pharmacol Sci. 2005;9(6):355-9.
11. 11-.Gao B, Jiang Y, Zhang X, et al. Surgical treatment of large substernal thyroid goitre: analysis of 12 patients. Int J Clin Exp Med. 2013,6(7):488-96.
12. 12-Kilic D, Findikcioglu A, Ekici Y, Alemdaroglu U, Hekimoglu K, Hatipoglu A. When is transthoracic approach indicated in retrosternal goitres? Ann Thorac Cardivasc Surg. 2011;17(3):250-3..
13. 13-Riffat F, Del Pero MM, Fish B, Jani P. Radiologically predicting when a sternotomy may be required in the management of retrosternal goitres. Ann Otol Rhinol Laryngol. 2013;122(1):15-9. 14-Qureishi A, Garas G, Tolley N, Palazzo F, Athanasiou T, Zacharakis E. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg. 2013;11(3):203-8. doi: 10.1016/j.ijsu.2013.01.006.
14. 15-Chen AY, Bernet VJ, Carty SE, et al. Surgical Affairs of the American Thyroid Association. American Thyroid Association Statement on Optimal Surgical Management of Goitre. Thyroid. 2014;24(2):181-9. doi: 10.1089/thy.2013.0291.
15. 16-Cohen JP. Substernal goitres and sternotomy. Laryngoscope. 2009;119(4):683-8. doi: 10.1002/lary.20102.
16. 17--Burns P, Doody J, Timon C. Strenotomy for substernal goitre: an otolaryngologist’s perspective. J Laryngol Otol. 2008;122(5):495-9.