Simo, Ricard1; Shamil, Eamon1; Muscat, Kenneth1; Hay, Ashley1; Goswamy, Jay1; Ryba, Francine1; Nixon, Iain1; Jeannon, Jean-Pierre1; Harrison-Phipps, Karen1
1 Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Background: Midline sternotomy (MS) in the surgical treatment of thyroid cancer (TC) is rarely necessary and therefore there is limited evidence in the literature. Sternotomy may be required when there is evidence of primary or nodal mediastinal involvement or recurrent disease. We review the indications and oncological outcomes of patients with TC requiring MS.
Methods: Prospective review of 370 consecutive patients diagnosed of TC between 2011 and 2016. 11 patients (0.29%) required MS. All patients were evaluated with USS-FNAC, Multiplanar CT scan and discussed in the Multidisciplinary Thyroid Oncology Board meeting. Surgery was performed by the head and neck and thoracic surgery teams. Minimum follow-up was 3 months and maximum follow up was 6 years.
Results: There were 5 males and 6 females. Age range 28 to 81 years. 10 patients underwent primary surgery and 1 for recurrent disease. Five patients had poorly differentiated carcinoma, 4 papillary carcinoma and 2 medullary carcinoma. Four patients had T4 tumours, 3 had T3 tumours, 3 had T2 and 1 patient had recurrent cancer. All patients had N1b nodal stage. Two patients had invasion of major vessels. 10 patients are alive and one patient died of intracranial metastases. 3 patients have persistent metastatic disease but only one has stable loco-regional recurrence. Seven patients alive with no recurrence.
Discussion & Conclusion: Midline sternotomy for TC can be performed with good oncological results and relatively minimal morbidity. A multidisciplinary approach by dedicated clinical teams is essential to obtain best outcome and minimal morbidity.