[Stomal metastases after translaryngeal tracheotomy (TLT) according to Fantoni: a rare complication]

The translaryngeal tracheotomy (TLT) according to Fantoni with rigid endoscopy is well known and easy to execute. In our department we have used this method since 2002. In 17 patients suffering from carcinomas of the upper aerodigestive tract, we performed a TLT. Peri- and postoperative complications were examined. In 17 patients there were no intraoperative complications. As an early complication we found in one case a dislocation of the tracheostomy tube postoperatively. In one patient we observed metastases in the prior TLT stoma as a major late complication. Another patient also probably suffered from metastases in the prior TLT stoma. We did not find tracheoesophageal fistulas or stenosis of the trachea. Iatrogenic neoplastic seeding of squamous cell carcinomas of the upper aerodigestive tract is a serious complication. Our experience with these two cases and a review of the literature indicates that in patients with head and neck cancer, pull procedures for placement of TLT tubes may induce metastases by direct implantation of tumor cells because of contact between the TLT tube and the primary tumor cells. TLT according to Fantoni cannot be recommended for the treatment of cancer of the upper aerodigestive tract. Methods of tube insertion that avoid such contact, e.g., Ciaglia, surgical tracheostomy, should be preferred.