Methodology.

Introduction Thyroid cancer frequently recurs in the superior or anterior mediastinum. Midline sternotomy is usually performed in order to dissect recurrent mediastinal cancers, but there is a high risk of haemorrhage that can result from unintentionally cutting the brachiocephalic veins adhering to the sternum. A safe and minimally invasive method is thus required for the treatment of recurrent thyroid cancer in the mediastinum. The objective of this study was to evaluate a novel method of removing the sternum by bone forceps for mediastinal dissection to determine its safety, aesthetic outcome and duration of hospitalisation, as compared with conventional reversed T-shaped sternotomy. Materials and methods A collar skin incision was made followed by the removal of the sternum by bone forceps. As a result, soft tissues, including the sternothyroid muscle, behind the sternum were exposed and cut, allowing the surgeon a clear area in which to observe great vessels in the mediastinum. Mediastinal dissection could then be performed safely because of the clear view afforded when retracting the brachiocephalic veins. After dissection, many pieces of the sternal bone were grafted back to the sternum and were subsequently covered with vascularised muscle tissue. * Corresponding author Email: [email protected] 113-8421, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan 1 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan 2 Department of Otolaryngology, Kyushu Rosai Hospital, Kitakyushu, Japan Twenty-one patients with recurrent thyroid carcinoma underwent this procedure between 2005 and 2010. The control group consisted of 12 patients treated by conventional methods between 2002 and 2004. The difference between the two groups was tested using Student’s ttest and Mann–Whitney test; p values <0.05 were considered to indicate significance. Results and Discussion The mean time for removal of the sternum was 11 min (9–15 min). After the sternum was removed, brachiocephalic veins could be clearly observed in the soft tissue. Mediastinal dissection could be performed safely because of the clear view provided, and it did not result in any complications. The mean blood loss for the new method group and that for the control group was 185 ml (35–530) and 278 ml (55–687), respectively. The mean surgical time for the new method group and the control group was 3 h 5 min and 3 h 58 min, respectively. The mean duration of hospitalisation for the new method group and the control group was 8.5 days (7–19) and 12.9 days (8–23), respectively. These three key areas of comparison were significantly different between the two groups. Patients were highly satisfied with the post-operative aesthetic results. This method is effective for the dissection of the central compartment rather than the lateral compartment. Conclusion This novel method of removing the sternum by bone forceps is more effective than the conventional method for mediastinal dissection of recurrent thyroid cancer in terms of safety, aesthetic outcome and duration of hospitalisation. Introduction Thyroid tumour frequently invades the superior or anterior mediastinum. In recurrent cases, large vessels closest behind the sternum frequently adhere to the sternum. Midline sternotomy is usually performed to dissect recurrent mediastinal cancers; however, the high risk of haemorrhage that can result from unintentionally cutting the brachiocephalic veins adhering to the sternum can cause great anxiety to the surgeon. These tumours occasionally occur in young female patients who may suffer severe scaring as a result of conventional midline sternotomy. Thus, a safe and minimally invasive method of operating is required for the treatment of recurrent thyroid cancer in the mediastinum.