Surgical treatment of upper mediastinum involvement following thyroid cancer surgery

: Four cases with mediastinal nodal involvements after surgery for thyroid cancer were treated by tumor extirpation and mediastinal lymph nodes dissection. The removal were performed via the median sternotomy in three cases and partial resection of the clavicle in one case. The transsternal approach made it possible to remove the tumor with mediastinal lymph nodes safely and easily. It is generally sufficient to carry out dissection as far as the brachiocephalic vein. However, mediastinal nodal involvements extending below the brachiocephalic vein were seen in one of 4 cases. All patients are alive, including 2 cases with lung metastases. Initial aggressive surgical treatment of mediastinal recurrence is important for preventing the obstruction of the trachea or large vessels.