Document Detail

As originally published in 1992: Anterior mediastinal tracheostomy with and without cervical exenteration. Updated in 1998.
MedLine Citation:
PMID:  10197709     Owner:  NLM     Status:  MEDLINE    
Anterior mediastinal tracheostomy (AMT) facilitates resection of stomal recurrences after laryngectomy for carcinoma and tumors involving the cervicothoracic trachea and esophagus. Erosion of the innominate artery has been reported as a frequent major complication of AMT, and routine prophylactic division of the innominate artery with AMT has even been advised. Forty-four patients underwent AMT, 10 as an isolated procedure (for stomal recurrence, laryngeal carcinoma, or benign stenosis after laryngectomy) and 34 with concomitant cervical exenteration (laryngopharyngoesophagectomy) for laryngeal, thyroid, or cervicothoracic esophageal malignancies. Transposition of the remaining tracheal stump beneath and to the right of the innominate artery to eliminate tension on the vessel was carried out in 14 patients (32%). Postoperatively, anastomotic leaks complicated nine of 31 pharyngogastric anastomoses. Iatrogenic hypoparathyroidism occurred in 10 patients. All six hospital deaths (14%) occurred in patients undergoing AMT with cervical exenteration, not isolated AMT. There was only one instance of innominate artery erosion. Survival was related to the pathology for which AMT was performed. Anterior mediastinal tracheostomy is a valuable adjunct in the treatment of select patients with malignancies of the cervicothoracic trachea and esophagus, and with attention to operative detail, innominate artery erosion should rarely, if ever, complicate the operation. Prophylactic division of the innominate artery with AMT is unnecessary.
M B Orringer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  67     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-04-23     Completed Date:  1999-04-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  591     Citation Subset:  AIM; IM    
Department of Surgery, The University of Michigan Medical Center, Ann Arbor 48109, USA.
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MeSH Terms
Esophageal Neoplasms / surgery*
Laryngectomy / methods
Neck Dissection / methods*
Neoplasm Recurrence, Local / surgery
Tracheal Neoplasms / surgery*
Tracheostomy / methods*

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