Introduction: Substernal goiters (SSGs) extending to posterior mediastinum which account for minority of total SSGs. In previous published reports, thoracic approaches were considered to surgical treatment for posterior medastinal goiter in most cases. The present report was to identify the clinical features of posterior mediastinal goiters and surgical treatment strategies on the basis of our experiences. Case presentation: Clinical data of 23 cases of posterior mediastinal goiters in 122 substernal goiters (SSGs) from a total of 4381 thyroidectomies performed in Division of thyroid surgery General Surgery Department of Xiangya hospital, Central South University, China over a 6-year period (2010-2016) was respectively were analyzed. Posterior mediastinal goiters have more prevalence of compression symptoms compared with anterior mediastinal goiters (P<0.05). SSGs which extend to posterior mediastinum have a higher probability of mass bottom below the aortic arch than those extending to anterior mediastinum (P<0.05). Twenty posterior mediastinal goiters (87.0%) underwent thyroidectomies by cervical approach without additional incision. In 3 of the 23 patients (13.0%), 1 thoracotomy and 2 thoracoscopic approaches were performed for a complete and safe removal. Postoperative complications occurred in 5 of 23 patients (21.7%) including temporary recurrent laryngeal nerve (RLN) paralysis and transient hypoparathyroidism in our series. Conclusion: Surgical removal of posterior mediastinal goiters can be performed safely by a single cervical approach in the majority of patients. Thoracoscopic approach proposes a new treatment strategy with feasibility.

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