{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T11:34:46Z","timestamp":1792755286670,"version":"4.5.0"},"reference-count":72,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2008,2,12]],"date-time":"2008-02-12T00:00:00Z","timestamp":1202774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A number of reports have been published concerning the surgical treatment of substernal goiters; however, there is yet to be a comprehensive review of this body of literature using evidence\u2010based methodology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This article is a systematic review of the literature using evidence\u2010based criteria and a review of unpublished data from our institution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Issue 1. Limited level III\/IV data suggest that the incidence of cancer in substernal goiters is not higher than the incidence of cancer in cervical goiters. Risk factors for malignancy in substernal goiters may include a family history of thyroid pathology, a history of cervical radiation therapy, recurrent goiter, and the presence of cervical adenopathy (grade C recommendation). Issue 2. Prospective level V data suggest that, for most patients, expert endocrine surgeons utilize an extracervical approach approximately 2% of the time to remove a substernal goiter safely; a sternotomy or thoracotomy appears more likely in cases of a primary substernal goiter or a mass larger than the thoracic inlet (no recommendation). Issue 3. There may be a higher rate of permanent hypoparathyroidism and unintentional permanent recurrent laryngeal nerve injury when total thyroidectomy is performed for removal of a substernal goiter than for removal of a cervical goiter alone (grade C recommendation). Injury of the external branch of the superior laryngeal nerve was not specifically addressed and is almost certainly underreported. Issue 4. The presence of a substernal goiter, especially being present more than 5 years and causing significant tracheal compression, is likely a risk factor for tracheomalacia and tracheostomy (grade C recommendation). Tracheomalacia with substernal goiter is an infrequent occurrence, and many cases of tracheomalacia can be managed without tracheostomy (no recommendation). Issue 5. Prospective level V data suggest that about 5% to 10% of operations for substernal goiters are performed because of recurrent or persistent disease, although retrospective level V data report an even higher rate, up to 37%. The most common initial operations with recurrence or persistence appear to be subtotal or hemithyroidectomy (no recommendation).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Evidence\u2010based recommendations provide reliable information regarding the pathologic findings and operative management of substernal goiters in expert hands.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-008-9466-3","type":"journal-article","created":{"date-parts":[[2008,2,11]],"date-time":"2008-02-11T18:05:19Z","timestamp":1202753119000},"page":"1285-1300","source":"Crossref","is-referenced-by-count":195,"title":["Evidence\u2010Based Surgical Management of Substernal Goiter"],"prefix":"10.1002","volume":"32","author":[{"given":"Matthew L.","family":"White","sequence":"first","affiliation":[{"name":"Division of Endocrine Surgery, Department of Surgery University of Michigan 2920 Taubman Center, 1500 East Medical Center Drive 48109\u20100331 Ann Arbor Michigan USA"},{"name":"Department of Surgery St. Joseph Mercy Hospital Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard M.","family":"Doherty","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery, Department of Surgery University of Michigan 2920 Taubman Center, 1500 East Medical Center Drive 48109\u20100331 Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul G.","family":"Gauger","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery, Department of Surgery University of Michigan 2920 Taubman Center, 1500 East Medical Center Drive 48109\u20100331 Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,2,12]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930600313"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.nu.10.070190.000321"},{"key":"e_1_2_9_4_2","first-page":"96","volume-title":"Disputationes Anatomica Selectae","author":"Haller A","year":"1749"},{"key":"e_1_2_9_5_2","first-page":"106","article-title":"Veber die Austrotting verschiedener geschwulste, besonders jener der Ohrspercheldruse und der Schiddruse; Aussachalung der Schilddruse","volume":"12","author":"Klein F","year":"1820","journal-title":"J Chir Augenlleilk"},{"key":"e_1_2_9_6_2","first-page":"969","article-title":"Rationale for the operative management of substernal goiters","volume":"94","author":"Allo MD","year":"1983","journal-title":"Surgery"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-7216-0139-7.50037-5"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003\u20104975(10)62645\u20108"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1992.01420050137018"},{"key":"e_1_2_9_10_2","first-page":"240","volume-title":"International Trends in General Thoracic Surgery. 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