Predictors of Sternotomy in Substernal Goiter Patients: A Systematic Review and Meta-Analysis.

Introduction: This study aimed to identify the preoperative risk factors for patients requiring sternotomy to treat substernal goiters (SGs), with the goal of enhancing preoperative planning and obtaining informed patient consent.

Methods: We accessed PubMed, Scopus, Web of Science, and the Cochrane Library for relevant studies through June 2024. We included all studies involving patients with SG who underwent sternotomy. We compared these patients to those who had their SG delivered without the need for sternotomy, focusing on identifying predictors of sternotomy. A 95% confidence interval and random-effects model were used to calculate the risk ratio (RR) for dichotomous outcomes and the mean difference for continuous outcomes in double-arm analyses, with proportions utilized in single-arm analyses.

Results: Forty-six studies were included in this review. We found that goiter extension below the aortic arch, posterior mediastinal extension, and the extension below the carina were associated with an increased likelihood of sternotomy (RR: 5.36, P < 0.00001; RR: 9.33, P < 0.00001; RR: 8.08, P = 0.005). We also found that a more extended duration history of goiter and symptomatic SGs were associated with an increased need for sternotomy (mean difference: 4.99, P < 0.001; RR: 2.98, P = 0.006), respectively.

Conclusions: The need for sternotomy in SG can be anticipated. This review identified several risk factors, including goiter extension below the aortic arch, posterior mediastinal goiter extension, and extension beneath the carina. In these instances, surgeons should not hesitate to perform sternotomy to reduce complications.