Indications and results of anterior mediastinal tracheostomy for malignancies

This study was designed to assess the early and long-term results, and determine suitable indications of anterior mediastinal tracheostomy, after radical resection for cervicothoracic malignancies.

From 1985 to 2009, 13 patients ranging in age from 40 to 75 years underwent an anterior mediastinal tracheostomy for malignancy, 2 as an isolated procedure, 5 with concomitant laryngectomy, and 6 with concomitant laryngopharyngoesophagectomy. The patients had subglottic carcinoma, proximal tracheal carcinoma invading the subglottic larynx (n = 6), stomal recurrence following laryngectomy (n = 4), esophageal carcinoma invading the proximal trachea (n = 2), or tracheal recurrence after conventional resection (n = 1). The postoperative course and outcome were assessed in all patients.

In 5 patients, the postoperative course was uneventful. There were 2 in-hospital deaths, and 6 patients experienced nonfatal complications including three pharyngocutaneous fistulas, two pharyngogastric or pharyngocolic anastomotic leaks, and one pulmonary embolism. Satisfactory airway was achieved in 7 patients presenting with proximal obstruction, and ability to tolerate oral feeding, in 2 patients with esophageal carcinoma. The mean follow-up time for survivors was 89 months (range, 9 to 201 months). Patients with esophageal carcinoma or recurrence of tracheal carcinoma showed a poor outcome. In contrast, in the subgroup of patients with head and neck malignancy, 3-year and 5-year survival rates were 57% and 43%, respectively.

Our results and survival analysis from the literature suggest that suitable indications for anterior mediastinal tracheostomy are (1) carcinoma of the subglottic region or proximal trachea invading the subglottic larynx, (2) stomal recurrence after laryngectomy, and (3) well-differentiated thyroid carcinoma invading the trachea or recurrence.