Ten-year experience with cervical miniesophagostomy

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Surgical Oncology

Background:

• Nasogastric tubes (NGTs) can cause laryngeal inflammation, vocal cord immobility, and delayed healing post-laryngeal surgery.
• Alternative feeding methods like gastrostomy tubes require specialized expertise and carry abdominal complication risks.
• Transcutaneous cervical miniesophagostomy (TCME) presents a potentially simpler, intraoperative solution for enteral alimentation.

Purpose of the Study:

• To evaluate the safety and efficacy of intraoperative transcutaneous cervical miniesophagostomy (TCME) in patients undergoing conservation laryngeal and/or hypopharyngeal surgery.
• To compare TCME with traditional nasogastric tubes and gastrostomy in terms of complications and recovery.
• To determine the indications for TCME in various laryngeal and hypopharyngeal cancer resections.

Main Methods:

• Retrospective review of 35 patients who underwent intraoperative TCME during conservation laryngeal/hypopharyngeal surgery.
• TCME procedure performed by head and neck surgeons during primary cancer surgery, taking approximately 5 minutes.
• Analysis of postoperative complications, feeding outcomes, and decannulation rates associated with TCME.

Main Results:

• TCME was successfully performed in 35 patients, providing enteral alimentation without NGT use.
• The procedure was associated with minimal postoperative morbidity and no leakage, attributed to tube orientation and tunneling.
• TCME proved effective in supraglottic laryngectomy, partial laryngectomy, partial laryngopharyngectomy, base of tongue resection, and selected hemilaryngectomy cases.

Conclusions:

• Intraoperative TCME is a safe, simple, and quick method for enteral feeding during laryngeal and hypopharyngeal cancer surgery.
• TCME avoids NGT-related complications and offers a viable alternative to gastrostomy, with minimal morbidity.
• TCME is particularly indicated when the arytenoid cartilage is removed or the posterior larynx is disrupted during surgery.