Paralysie récurrentielle et goitre sous-sternal : une étude multicentrique italienne

The aim of this retrospective multicentre study was to verify whether the substernal goitre and the type of surgical access could be risk factors for recurrent laryngeal nerve palsy during total thyroidectomy. In total, 14,993 patients underwent total thyroidectomy between 1999-2008. Patients were divided into three groups: Group A (control; n = 14,200, 94.7%), cervical goiters treated through collar incision; Group B (n = 743, 5.0%) substernal goiters treated by cervical approach; Group C (n = 50, 0.3%) in which a manubriotomy was performed. Transient and permanent monolateral palsy were significantly more frequent in B + C vs A (P = <0.001) and in B vs A (P = <0.001). Transient bilateral palsy was significantly more frequent in B + C vs A (P = <0.043) and in C vs A (P = <016). Permanent bilateral palsy was significantly more frequent in B + C vs A (P = <0.041), and in B vs A (P = <0.037). The mediastinal extension of the goiter was associated to increased risk of recurrent nerve palsy during total thyroidectomy.