Abstract
Between 1978 and 1993 we experienced 143 mediastinal surgery for the head and neck cancer. Indications for this surgery include 1) tumor extension to the mediastinum, 2) presence of mediastinal metastasis, 3) postoperative tracheal necrosis, 4) stomal recurrence, 5) postoperative esophageal stenosis and fistulas. the extent of mediastinal dissection was to the level of the carina and tumors extending to the pleura or vessels were not necessarily contraindicated in selected patients. The maximam tracheal resection was 1.5cm from the carina.
The most significant problem of mediastinal surgery is postoperative complications around the tracheostoma in post-laryngectomy patients which easily resulting in fatal innominate artery hemorrhage. In our series we have experienced 4 postoperative innominate artery hemorrhage and two patients died because of it. To prevent these complications careful attention must be paid to the following points, to avoid undue tension at the tracheal cutaneous suture line, to keep sufficient blood supply to the tracheal stump, to protect major arteries using some type of the muscule flap if necessary. In case of the short trachea We usually resect the sternum, the clavicular head and the ribs as wide as necessary, and rotate a myocutaneous or muscle flap such as pectoralis maior, latissimus dorsi, rectus abdominal etc, to insert between the trachea and the innominate artery to prevent tracheo-innominate fistulas. And then in case of extremely short trachea we use the free radial forearm flap on it for resurfacing of mediastinum. The 5-year survival is as follows; thyroid 47.1%, hypopharynx 38.7%, cervical esophagus 30.6%, larynx 21.4%, stomal recurrence 15.2%.
