Affiliation:
1. Department of Otolaryngology–Head and Neck Surgery Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
2. Robert Wood Johnson Library of the Health Sciences New Brunswick New Jersey USA
3. Department of Obstetrics and Gynecology University of Pennsylvania Philadelphia Pennsylvania USA
Abstract
AbstractObjectiveTo evaluate the prevalence of extracervical approaches (ECAs) for substernal goiter (SSG) excision.Data SourcesSearch strategies created in collaboration with a medical librarian were implemented using PubMed, Cochrane, Scopus, Web of Science, and Google Scholar from inception to July 2021.Review MethodsParticipants included adults ages >18 years undergoing SSG excision. The primary outcome was rate of ECA via sternotomy or thoracotomy. Studies were categorized into the 3 most common distinct definitions: goiter descending below the plane of the thoracic inlet (definition 1), ≥50% of thyroid mass extending below the sternal notch (definition 2), and goiter extending ≥3 cm below the suprasternal notch when the neck is hyperextended (definition 3). Two reviewers independently extracted data for analysis and performed a quality assessment using the Methodological Index for Non‐Randomized Studies criteria.ResultsOf the 551 studies identified, 69 studies were included for analysis. Definition 1 included 3441 patients from 31 studies; definition 2 included 2957 patients from 26 studies; and definition 3 included 2921 patients from 12 studies. A random‐effect model estimating the pooled prevalence of ECA using definition 1 resulted in prevalence of 6.12% (95% confidence interval: 3.48‐9.34, I2 = 90.72%).ConclusionExtension below the thoracic inlet is the most widely used definition of SSG. Approximately 6% of patients with a SSG undergo an ECA. Patients with SSG undergoing surgery should be counseled on the prevalence, risks, and morbidity of an ECA in the rare occurrence it is needed.
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