International Journal of Surgery 12 (2014) 885
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Letter to the Editor
Goitre or “goiter” e A missed opportunity? Conflicts of interest
Sir, I noticed that Qureishi et al. [1] only used one spelling of goitre in their Best-Evidence Topic (BET) search strategy. Goitre can also be spelt “goiter” and many papers exist in the world literature with this spelling as it is a MeSH heading. They state that “all studies were retrospective” e in fact, if they were to repeat this search using “goitre” and “goiter”, they would retrieve two prospective studies [2,3] which could have potentially been included. This brings me on to my second point. Qureishi et al. used a restrictive definition of retrosternal goitre: “>50% of its mass below the thoracic inlet”. I appreciate this is the commonest definition and provides an exclusion criterion to aid selection of papers. However, this also limits the generalisability of their BET and would exclude the two aforementioned prospective papers from their study, thus limiting the overall level of evidence reviewed. Sari et al. [2] undertook a prospective study of 260 patients with retrosternal goitre (of various definitions) and found a strong positive correlation between need for sternotomy and three independent factors: harder thyroid tissue radiodensity, posterior location and subcarinal extension as predicted using computed tomography (CT) imaging. Pata et al. [3] undertook a prospective study of 102 patients with retrosternal goitre and found that CT evidence of retrosternal extension past the tracheal bifurcation to the aortic root predicted the need for minimal upper sternotomy (sternal-split) after an initial cervicotomy. These two studies [2,3] have their own methodological limitations; however, I feel that their exclusion, by virtue of the search strategy that Qureishi et al. employed, represented a missed opportunity for this BET.
None. Funding None. Author contribution GM is the sole author of this correspondence and accepts full responsibility for scientific content.
References [1] A. Qureishi, G. Garas, N. Tolley, F. Palazzo, T. Athanasiou, E. Zacharakis, Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int. J. Surg. 11 (2013) 203e208. €z, et al., Predictive value of thyroid tissue density in deter[2] S. Sari, Y. Erbil, F. Erso mining the patients on whom sternotomy should be performed, J. Surg. Res. 174 (2012) 312e318. [3] G. Pata, C. Casella, M. Benvenuti, N. Crea, E. Di Betta, B. Salerni, 'Ad hoc' sternalsplit safely replaces full sternotomy for thyroidectomy requiring thoracic access, Am. Surg. 76 (2010) 1240e1243.
Gordon A.G. McKenzie College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, West Midlands B15 2TT, UK E-mail address: [email protected].
Ethical approval None.
http://dx.doi.org/10.1016/j.ijsu.2014.07.001 1743-9191/© 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
21 December 2013 Available online 4 July 2014
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Letter to the Editor
Goitre or “goiter” e A missed opportunity? Conflicts of interest
Sir, I noticed that Qureishi et al. [1] only used one spelling of goitre in their Best-Evidence Topic (BET) search strategy. Goitre can also be spelt “goiter” and many papers exist in the world literature with this spelling as it is a MeSH heading. They state that “all studies were retrospective” e in fact, if they were to repeat this search using “goitre” and “goiter”, they would retrieve two prospective studies [2,3] which could have potentially been included. This brings me on to my second point. Qureishi et al. used a restrictive definition of retrosternal goitre: “>50% of its mass below the thoracic inlet”. I appreciate this is the commonest definition and provides an exclusion criterion to aid selection of papers. However, this also limits the generalisability of their BET and would exclude the two aforementioned prospective papers from their study, thus limiting the overall level of evidence reviewed. Sari et al. [2] undertook a prospective study of 260 patients with retrosternal goitre (of various definitions) and found a strong positive correlation between need for sternotomy and three independent factors: harder thyroid tissue radiodensity, posterior location and subcarinal extension as predicted using computed tomography (CT) imaging. Pata et al. [3] undertook a prospective study of 102 patients with retrosternal goitre and found that CT evidence of retrosternal extension past the tracheal bifurcation to the aortic root predicted the need for minimal upper sternotomy (sternal-split) after an initial cervicotomy. These two studies [2,3] have their own methodological limitations; however, I feel that their exclusion, by virtue of the search strategy that Qureishi et al. employed, represented a missed opportunity for this BET.
None. Funding None. Author contribution GM is the sole author of this correspondence and accepts full responsibility for scientific content.
References [1] A. Qureishi, G. Garas, N. Tolley, F. Palazzo, T. Athanasiou, E. Zacharakis, Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int. J. Surg. 11 (2013) 203e208. €z, et al., Predictive value of thyroid tissue density in deter[2] S. Sari, Y. Erbil, F. Erso mining the patients on whom sternotomy should be performed, J. Surg. Res. 174 (2012) 312e318. [3] G. Pata, C. Casella, M. Benvenuti, N. Crea, E. Di Betta, B. Salerni, 'Ad hoc' sternalsplit safely replaces full sternotomy for thyroidectomy requiring thoracic access, Am. Surg. 76 (2010) 1240e1243.
Gordon A.G. McKenzie College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, West Midlands B15 2TT, UK E-mail address: [email protected].
Ethical approval None.
http://dx.doi.org/10.1016/j.ijsu.2014.07.001 1743-9191/© 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
21 December 2013 Available online 4 July 2014
