Transsternal radical neck dissection. Postoperative complications and management

Area of Science:

• Surgical Oncology
• Head and Neck Surgery
• Otolaryngology

Background:

• Transsternal radical neck dissection (TRND) was first reported in 1962 for peristomal recurrence post-laryngectomy.
• This procedure addresses advanced head and neck cancer recurrence in a challenging anatomical region.
• Early outcomes were associated with significant postoperative complications.

Purpose of the Study:

• To review the authors' experience with over 50 TRND procedures over 14 years.
• To illustrate common intraoperative and postoperative complications associated with TRND.
• To discuss the management strategies for these complications and their impact on outcomes.

Main Methods:

• Retrospective review of over 50 transsternal radical neck dissections performed over 14 years.
• Analysis of intraoperative and postoperative complications encountered in early and later cases.
• Case illustration of specific complications and their management.

Main Results:

• Early cases experienced high rates of postoperative morbidity, including fistula, infection, and large vessel rupture.
• The authors' experience led to improved management of complications.
• Morbidity and mortality rates have decreased with increased surgical experience and refined complication management.

Conclusions:

• Transsternal radical neck dissection is a viable, albeit complex, option for managing peristomal recurrence after laryngectomy.
• Careful patient selection and experienced management of potential complications are crucial for successful outcomes.
• Surgical experience significantly improves the safety and efficacy of this procedure, reducing patient morbidity and mortality.