IN CANCER of the thyroid gland the downward spread of the disease by way of lymphatic vessels extending below the isthmus to nodes lying within the anterior portion of the superior mediastinum has been observed both at operation and at autopsy. The following anatomical dissections were done in order to devise a method for surgical removal of the tissues below the thyroid in continuity with the anterior superior mediastinal structures.
The customary transverse lower cervical thyroidectomy incision was enlarged downward with a vertical incision in the midline to expose the upper three-fourths of the sternum. The sternum was divided vertically downward from the sternal notch to the level of the fifth intercostal space, then transversely into each fifth intercostal space as far laterally as the internal mammary vessels, which were isolated and ligated. The pleurae were dissected laterally away from the anterior superior mediastinal structures to the phrenic nerves on