Anterior mediastinal tracheostomy with and without cervical exenteration

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Head and Neck Surgery

Background:

• Anterior mediastinal tracheostomy (AMT) is utilized for resecting recurrent cancers and tumors in the cervicothoracic region.
• Innominate artery erosion is a known, significant complication of AMT, leading to recommendations for prophylactic artery division.

Purpose of the Study:

• To evaluate the safety and efficacy of anterior mediastinal tracheostomy (AMT).
• To assess the incidence of innominate artery erosion and other complications associated with AMT.
• To determine the necessity of prophylactic innominate artery division during AMT.

Main Methods:

• Retrospective analysis of 44 patients undergoing AMT.
• Categorization of procedures into isolated AMT and AMT with cervical exenteration.
• Documentation of surgical techniques, including tracheal stump transposition.
• Recording of postoperative complications such as anastomotic leaks, hypoparathyroidism, and innominate artery erosion.
• Analysis of survival rates based on pathology.

Main Results:

• Only one instance of innominate artery erosion occurred in 44 patients.
• Six hospital deaths (14%) were observed, exclusively in patients undergoing AMT with cervical exenteration.
• Anastomotic leaks occurred in 9 of 31 pharyngogastric anastomoses.
• Iatrogenic hypoparathyroidism was noted in 10 patients.
• Tracheal stump transposition was performed in 14 patients (32%) to reduce tension on the innominate artery.

Conclusions:

• Anterior mediastinal tracheostomy is a beneficial procedure for select patients with cervicothoracic malignancies.
• Meticulous surgical technique minimizes the risk of innominate artery erosion.
• Prophylactic division of the innominate artery is not necessary for anterior mediastinal tracheostomy.