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Mediastinal tracheostomy
T Maipang1, S Singha, C Panjapiyakul
1Department of Surgery, Faculty of Medicine, Prince of Songkla University Hat-Yai, Thailand.
American Journal of Surgery
|June 1, 1996
Summary
Mediastinal tracheostomy offers a viable surgical solution for advanced lower neck and upper mediastinal cancers. This technique improves airway patency and swallowing function, providing palliation and potential cure for challenging malignancies.
Area of Science:
- Surgical Oncology
- Thoracic Surgery
- Head and Neck Surgery
Background:
- Advanced lower neck cancers extending to the superior mediastinum present significant surgical challenges.
- Radical tumor removal necessitates extensive resection including larynx, trachea, and esophagus.
- Intrathoracic tracheostomy construction is required for airway management.
Purpose of the Study:
- To present surgical experience and technique for managing difficult cervicothoracic tumors.
- To describe the procedure for mediastinal tracheostomy and distal tracheal reconstruction.
- To evaluate the outcomes of mediastinal tracheostomy in patients with advanced malignancies.
Main Methods:
- Performed twelve mediastinal tracheostomies.
- Most patients underwent total laryngopharyngectomy and tumor resection with gastric pull-up.
- A technique for reconstructing very short segments of the distal trachea was employed.
Main Results:
- Two operative deaths occurred due to tracheoinnominate artery fistula and cerebral infarction.
- Complications included pharyngeal fistula, respiratory failure, and sternal osteomyelitis.
- Survivors achieved good airway patency and dysphagia relief, with survival dependent on disease stage.
Conclusions:
- Mediastinal tracheostomy represents an advancement in surgical treatment for cervicothoracic malignancies.
- Careful patient selection is crucial for successful outcomes.
- The procedure offers good palliation, potential cure, and acceptable quality of life.