V-007ANTERIOR MEDIASTINAL TRACHEOSTOMY AFTER RECURRENCE OF LARYNGEAL CANCER

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (suppl_1), p.S2-S3
• Main Authors: Boada, Marc, Cladellas, E., Berthet, J.-P., Gimferrer, J., Molins, L., Gomez-Caro, A.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.7

Objectives To show the surgical technique and modifications of anterior mediastinal tracheostomy (ATM). Methods A 67-year-old male underwent a total laryngectomy plus chemoradiotherapy due to larynx squamous cell cancer 5 years ago. Follow-up cervicothoracic CT scan and visual inspection showed a local recurrence involving the previous tracheostomy and adjacent tissues. Uncontrolled distant metastases were ruled out and the patient was scheduled for oncological resection and anterior mediastinal tracheostomy. Previous tracheostomy and encompassing skin and soft tissues were resected to achieve R0. After trachea and oesophagus dissection, specimen was removed and lower tracheal ring (inferior limit) was checked by frozen section. Cervical and mediastinal lymphatic and fat tissue was also carefully removed to accomplish the oncological resection. Excision of the manubrium of the sternum and inner third of first and second clavicles in both sides was carried out for AMT construction, exposing the innominate vessels. To avoid trachea-innominate fistula, airway was moved under the innominate artery and a myocutaneous pectoral flap was used to fill in the dead spaces and minimize the postoperative chest wall instability. New ATM was constructed in the midline of the skin island of the myocutaneous flap to avoid dehiscence and deep infection caused by the healing impairement for the previous radiotherapy. Results The patient had a postoperative pneumonia and respiratory failure needing mechanical ventilation and difficult weaning. After 86 days the patient was discharged at home without quality of life deterioration regarding the previous status. Conclusions Anterior mediastinal tracheostomy is a feasible and reliable technique to treat patients with local recurrence of previous laryngeal tumours. Difficult postoperative management is the rule due to transitory respiratory insufficiency and wound dehiscence due to radiotherapy. However, a careful candidate selection is essential for excellent oncological and postoperative results. Disclosure All authors have declared no conflicts of interest.