MEDIASTINAL TRACHEOSTOMY

Abstract

Mediastinal tracheostomy was performed to establish an airway after resection of advanced tumor in the cervicothoracic region, such as trachea or esophagus. Historically, radical operations involving superior mediastinum have been associated with high operative mortality, secondary to mediastinal infection and rupture of the innominate artery. To analyze the operative procedures and the complications of mediastinal tracheostomy, the authors performed a retrospective review of their 9-year experience of mediastinal tracheostomy at the Cancer Institute Hospital in Tokyo. Thirty-two patients were resected a part of the manubrium and the medial right clavicle. The trachea was transposed to the right of the innominate artery in 36 patients. DP flap was used for resurfacing the anterior neck and mediasinum around tracheostome in 26 patients. There were 2 operative deaths, 1 from esophago-innominate artery fistula and the other from respiratory failure. There was an overall wound complication rate of 76% (29 of 38). These included major vessel rupture of the mediastinum in two and wound dehiscence of tracheostome in 14 patients. Mechanical ventilatory support was required in 4 patients, three of whom had partial necrosis of the tracheal wall. All patients who survived the operation achieved good airway patency and relief of dysphagia. By careful selection of patients, successful operation resulted in acceptable quality of life.