Mediastinothoracic approaches in surgery for thyroid cancerDer mediastinale Zugang in der Therapie des Schilddrüsenkarzinoms

BACKGROUND: Surgical access to the mediastinum is performed to achieve surgical safety, radicality, and a clear surgical field. METHODS: In our institutions, mediastinal approaches were used in 0.1% of patients with benign goiters and 4.2% of patients with thyroid carcinoma. Surgical approaches were summarised into four groups: partial median sternotomy, sternocostoclavicular resection or parasternal thoracotomy, mediastinothoracic approach and partial resection of thoracic wall. RESULTS: Indication for mediastinal access was lymphadenectomy in 22, lymph node recurrence in 6, visceral invasion in 14, and osseous invasion in 14 patients. Two postoperative hematomas and one osseous necrosis after sternocostoclavicular resection were observed. CONCLUSIONS: Partial median sternotomy is useful for systematic mediastinal lymphadenectomy. For access to the lateral parts of the mediastinum, sternocostoclavicular resection or parasternal thoracotomy is more suitable. Exposure of the surgical field is achieved best by a mediastinothoracic approach.