Anterior mediastinal tracheostomy

Anterior mediastinal tracheostomy is not a commonly performed operation. The procedure, however, clearly facilitates resection of cervicothoracic, tracheal, and esophageal malignancies. Of 49 cervical exenterations performed, in 35 (71%) a concomitant mediastinal tracheostomy was performed, similar to the 77% rate of mediastinal tracheostomy with cervical exenteration reported by Grillo and Mathisen. There is little question that anterior mediastinal tracheostomy combined with cervical exenteration, transhiatal esophagectomy, and a primary pharyngogastric anastomosis is a formidable technical exercise. Although this operative approach provides effective palliation and occasionally cure in patients with compromise of their airway, swallowing ability, or both, careful patient selection, meticulous attention to operative detail, and intensive postoperative care are mandatory in order to achieve a successful outcome with acceptable morbidity and mortality rates.