{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T20:25:05Z","timestamp":1769286305504,"version":"3.49.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Substernal goiters (SGs) with significant mediastinal extension can present complex surgical dilemmas. While most SGs can be resected through a low cervical collar incision, a full median sternotomy may be required in select cases. Morbidly obese patients are susceptible to adverse outcomes following full sternotomy, such as wound infection and sternal dehiscence. Partial upper sternotomy is a safe, effective alternative that offers sufficient access to the mediastinum while minimizing surgical morbidity, making it a valuable approach in this high-risk population. We present the case of a 33-year-old female with a BMI of 47\u00a0kg\/m2 who was found to have a large symptomatic SG with significant mediastinal extension. Due to the depth of extension, a combined cervical and trans-sternal approach was planned. A partial upper sternotomy was performed to avoid the morbidity of full sternotomy. The patient tolerated the procedure well without complications and was discharged home on postoperative day two.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf1085","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:39:37Z","timestamp":1767789577000},"source":"Crossref","is-referenced-by-count":0,"title":["Partial upper sternotomy for resection of a large substernal goiter in a high-risk patient"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4993-8911","authenticated-orcid":false,"given":"Nasim","family":"Kasiri","sequence":"first","affiliation":[{"name":"Stritch School of Medicine, Loyola University Chicago , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Pohlman","sequence":"additional","affiliation":[{"name":"Stritch School of Medicine, Loyola University Chicago , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]},{"name":"Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]},{"name":"Department of Surgery, University of Illinois Chicago , 840 S Wood St., Chicago, IL 60612 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea M","family":"Ziegler","sequence":"additional","affiliation":[{"name":"Stritch School of Medicine, Loyola University Chicago , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]},{"name":"Department of Otolaryngology, Loyola University Medical Center , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaid M","family":"Abdelsattar","sequence":"additional","affiliation":[{"name":"Stritch School of Medicine, Loyola University Chicago , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]},{"name":"Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]},{"name":"Department of Surgery, Edward Hines Jr. Veterans Affairs Hospital , 5000 5th Ave, Hines, IL 60141 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia M","family":"Coughlin","sequence":"additional","affiliation":[{"name":"Stritch School of Medicine, Loyola University Chicago , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]},{"name":"Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center , 2160 S 1st Ave, Maywood, IL 60153 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"2026012010272477800_ref1","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.otc.2023.07.008","article-title":"Surgical management of substernal thyroid goiters","volume":"57","author":"Bastien","year":"2024","journal-title":"Otolaryngol Clin North Am"},{"key":"2026012010272477800_ref2","first-page":"827","article-title":"Surgical management of substernal goiter","volume":"99","author":"Shai","year":"2000","journal-title":"J Formos Med Assoc"},{"key":"2026012010272477800_ref3","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1177\/000313481808400235","article-title":"Substernal goiter: correlation between grade and surgical approach","volume":"84","author":"Ch\u00e1vez Tostado","year":"2018","journal-title":"Am Surg"},{"key":"2026012010272477800_ref4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.9738\/INTSURG-D-13-00275.1","article-title":"Should subtotal thyroidectomy be abandoned in multinodular goiter patients from endemic regions requiring surgery?","volume":"100","author":"Yoldas","year":"2015","journal-title":"Int Surg"},{"key":"2026012010272477800_ref5","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1245\/s10434-011-1596-4","article-title":"Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients","volume":"18","author":"Testini","year":"2011","journal-title":"Ann Surg Oncol"},{"key":"2026012010272477800_ref6","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1177\/000313481007601125","article-title":"\u2018Ad hoc\u2019 sternal-split safely replaces full sternotomy for thyroidectomy requiring thoracic access","volume":"76","author":"Pata","year":"2010","journal-title":"Am Surg"},{"key":"2026012010272477800_ref7","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1016\/j.ijsu.2015.12.058","article-title":"Surgical approach to mediastinal goiter: an update based on a retrospective cohort study","volume":"28","author":"Polistena","year":"2016","journal-title":"Int J Sur"},{"key":"2026012010272477800_ref8","author":"Can","year":"2025"},{"key":"2026012010272477800_ref9","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.2147\/OTT.S95352","article-title":"Complete transthoracic resection of giant posterior mediastinal goiter: case report and review of surgical strategies","volume":"9","author":"Zhao","year":"2016","journal-title":"Onco Targets Ther"},{"key":"2026012010272477800_ref10","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1016\/j.surg.2022.06.026","article-title":"Depth of mediastinal extension can predict sternotomy need for substernal thyroid goiters","volume":"172","author":"Linhares","year":"2022","journal-title":"Surgery"},{"key":"2026012010272477800_ref11","doi-asserted-by":"publisher","first-page":"708","DOI":"10.29271\/jcpsp.2025.06.708","article-title":"A new metric classification system for surgical management of retrosternal goitres","volume":"35","author":"Mukhtar","year":"2025","journal-title":"J Coll Physicians Surg Pak"},{"key":"2026012010272477800_ref12","doi-asserted-by":"publisher","first-page":"419","DOI":"10.9738\/INTSURG-D-14-00041.1","article-title":"Substernal goiter: when is a sternotomy required?","volume":"99","author":"Coskun","year":"2014","journal-title":"Int Surg"},{"key":"2026012010272477800_ref13","doi-asserted-by":"publisher","first-page":"e003831","DOI":"10.1161\/JAHA.116.003831","article-title":"Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery","volume":"6","author":"Ghanta","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2026012010272477800_ref14","doi-asserted-by":"publisher","first-page":"350","DOI":"10.5694\/j.1326-5377.2007.tb00935.x","article-title":"Obesity and early complications after cardiac surgery","volume":"186","author":"Yap","year":"2007","journal-title":"Med J Aust"},{"key":"2026012010272477800_ref15","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1186\/s12872-023-03410-9","article-title":"Comparative effects of minimally invasive approaches vs. conventional for obese patients undergoing aortic valve replacement: a systematic review and network meta-analysis","volume":"23","author":"Abdelaal","year":"2023","journal-title":"BMC Cardiovasc Disord"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/1\/rjaf1085\/66475367\/rjaf1085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/1\/rjaf1085\/66475367\/rjaf1085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T15:27:32Z","timestamp":1768922852000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf1085\/8431479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,24]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12,24]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf1085","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,12,24]]},"article-number":"rjaf1085"}}