The authors have no funding, financial relationships, or conflicts of interest to disclose.
Head and Neck
Manubrial resection and anterior mediastinal tracheostomy: Friend or Foe?†
Article first published online: 18 MAY 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 7, pages 1441–1445, July 2011
How to Cite
Chan, Y. W., Yu Chow, V. L., Lun Liu, L. H. and Ignace Wei, W. (2011), Manubrial resection and anterior mediastinal tracheostomy: Friend or Foe?. The Laryngoscope, 121: 1441–1445. doi: 10.1002/lary.21852
- Issue published online: 16 JUN 2011
- Article first published online: 18 MAY 2011
- Manuscript Accepted: 22 FEB 2011
- Manuscript Revised: 17 FEB 2011
- Manuscript Received: 5 JAN 2011
- Manubrial resection;
- anterior mediastinal tracheostomy;
- innominate artery rupture;
- stenosis of tracheostomy;
- Level of Evidence: 4
To review our experience with manubrial resection and anterior mediastinal tracheostomy and formulate operative guidelines to improve the surgical outcome.
Between January 1980 and June 2010, we performed 38 manubrial resections. The indications of the procedure, reconstructive methods, and operative outcomes were analyzed.
Fourteen patients had tumors of the hypopharynx/cervical esophagus, eight had parastomal recurrences of laryngeal tumor, four had recurrent esophageal tumors, four had postirradiation sarcoma, four suffered from subglottic/upper tracheal tumors, three had thyroid malignancy, and the remaining patient had tumor recurrence at the previous tracheostomy site. The hospital mortality rate was 5.3% due to bleeding from major vessel erosion. The mean length of the tracheal stump was 5.4 cm, of which 81.6% required relocation inferior to the innominate artery for construction of the mediastinal tracheostomy. Among the different reconstructive methods for the pharyngoesophageal defects, the anastomotic leakage rate was 17.6%, the majority of which required exteriorization followed by second stage reconstruction. The long-term tracheostomy stenosis rate was 47.4%, the risk of which was significantly increased by anastomotic leakage and necrosis of distal trachea. The use of a pectoralis major flap was shown to protect against this complication. The overall survival was 80.6% at 1 year and 55.6% at 5 years after surgery.
With attention to operative details, manubrial resection and anterior mediastinal tracheostomy is a safe procedure with acceptable outcome. It should be performed when indicated to facilitate tumor resection in the cervicothoracic region.