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Thorascopic staging of stomal recurrence
M K Wax1, J D Garnett, G Graeber
1Department of Otolaryngology, West Virginia University, Morgantown 26506, USA.
Head & Neck
|September 1, 1995
Summary
Thoracoscopy aids in determining surgical resectability for patients with stomal recurrence. This endoscopic technique offers crucial insights into mediastinal involvement, improving patient evaluation before extensive surgery.
Area of Science:
- Thoracic surgery
- Surgical oncology
- Diagnostic endoscopy
Background:
- Stomal recurrence following laryngectomy presents a significant challenge, often in patients with prior surgery and radiotherapy.
- Management of low cervical squamous cell carcinoma, including peritracheal metastasis and esophageal disease, historically had poor outcomes.
- Trans-sternal radical neck dissection improved management, but resectability assessment remained difficult prior to surgery.
Observation:
- Thoracoscopy, an endoscopic procedure, allows direct visualization of mediastinal structures.
- This technique involves inserting trocars into the thoracic cavity for detailed evaluation of tracheal, esophageal, and great vessel invasion.
- In this study, thoracoscopy was prospectively used alongside CT and MRI for patients with stomal recurrence.
Findings:
- Thoracoscopy provided critical information for determining surgical resectability in patients with stomal recurrence.
- One patient with no mediastinal involvement underwent successful resection and reconstruction, remaining disease-free.
- Two patients were found to have unresectable disease involving mediastinal great vessels or the subclavian artery, receiving palliative treatment.
Implications:
- Thoracoscopy is a valuable tool for assessing the mediastinal extent of stomal recurrence, aiding surgical planning.
- This minimally invasive approach can prevent unnecessary exploratory thoracotomies.
- The findings suggest thoracoscopy should be considered in the otolaryngologic evaluation of mediastinal disease.