Mediastinal tracheostomy during esophagectomy for cervicothoracic esophageal carcinoma invading the proximal trachea.

A total of 16 patients with carcinoma in the cervicothoracic esophagus underwent pharyngolaryngoesophagectomy with construction of a mediastinal tracheostoma. Among them, seven patients underwent transhiatal esophagectomy without thoracotomy, four proximal esophagectomy by cervicotomy and sternal split, and five cervical and thoracic esophagectomy and lymphadenectomy by cervicotomy and right thoracotomy. Free jejunal transfer was performed to reconstruct the esophagus in five patients, and the stomachs were used in ten. One patient died of pneumonia 27 days after surgery, and two of arterial blowout. Plastic and reconstructive surgery techniques were introduced to protect large vessels and cover the wound. The postoperative 30-day mortality was 6.3% and the total operative mortality was 18.8%. Median survival was 327 days. Mediastinal tracheostomy is safely applicable today for patients with esophageal carcinoma invading the proximal trachea, allowing them to achieve safe respiration and to enjoy meals.