{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:26:53Z","timestamp":1787869613964,"version":"build-2784847793"},"reference-count":124,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Defining indication for intervention in substernal goiter, and secondarily define when thoracic intervention may be required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>PubMed, Scopus, CINAHL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis were performed on studies employing thyroidectomy for substernal goiters. Meta\u2010analysis of continuous measures, proportions, and comparison of weighted proportions was performed for patient characteristics, symptoms, and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data from 102 studies were included, with a total study population of 15,719 patients undergoing substernal thyroidectomies. Criteria for classifying substernal goiter were heterogeneous across studies, with a plurality (21\/102) defining diagnosis by &gt;\u200950% of the goiter mass located below the thoracic inlet. There was a female predominance at 67% (CI 64.2\u201369.9) with a mean age of 58\u2009years old (10\u201394). Most common preoperative symptoms were a described \u201cneck mass\u201d (71.1%, CI 57.6\u201382.9) and overall compressive symptoms (64.8%, CI 52.4\u201376.2). 27.6% (CI 22.4\u201333.1) of the population remained asymptomatic. On radiologic imaging, tracheal deviation and compression were identified in 60.6% (CI 52.5\u201368.5) and 48.6% (CI 37.6\u201359.6) of the population, respectively. Cervical approach alone was performed in 88.7% (CI 86.0\u201391.1) of the population, while 10.4% (CI 8.2\u201312.8) required additional thoracic intervention. Malignancy was moderate and seen in 12.4% (CI 10.4\u201314.6) of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Results highlight the indication for substernal surgery is largely due to the presence of clinical symptoms or compressive findings on imaging; however, over a quarter of the population is asymptomatic and over 50% are without compressive findings on imaging. When surgery is undertaken, a cervical approach is often adequate, suggesting that only a minority of the population may require thoracic intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70087","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T08:50:17Z","timestamp":1756198217000},"page":"575-585","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical Management of Substernal Goiters: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4888-9382","authenticated-orcid":false,"given":"Matthew H.","family":"Cheung","sequence":"first","affiliation":[{"name":"Medical University of South Carolina Department of Otolaryngology\u2010Head and Neck Surgery  Charleston South Carolina USA"},{"name":"SUNY Upstate Medical University School of Medicine  Syracuse New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica M.","family":"Walker","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina Department of Otolaryngology\u2010Head and Neck Surgery  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0664-4571","authenticated-orcid":false,"given":"Shaun A.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina Department of Otolaryngology\u2010Head and Neck Surgery  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hank","family":"Butehorn","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina Department of Otolaryngology\u2010Head and Neck Surgery  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William G.","family":"Albergotti","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina Department of Otolaryngology\u2010Head and Neck Surgery  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Goiter. 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