A Case of Esophageal Cancer Involving Trachea Undergone Anterior Mediastinal Tracheostomy with Pedicled Omental Flap

Yoshiyuki Kuwabara, Masami Mitani, Noriyuki Sinoda, Atsushi Sato, Akira Mitsui Masahiko Sugiura, Tomotaka Suzuki, Joji Kato and Yoshitaka Fujii

Deaprtment of Surgery II, Nagoya City University Medical School, Nagoya, Japan

We present a case of esophageal cancer involving the trachea. The patient received an anterior mediastinal tracheostomy with pedicled omental flap following a total laryngo-esophagectomy and reconstruction using the stomach. Patient: A 54-year-old man. Operation: In the left lateral position, the entire intrathoracic esophagus and its associated mediastinal lymph nodes were mobilozed through the right fifth intercostalspace. In the supine position, a large U-shaped incision was made on the neck, and a vertical midline incision was made from bottom of the U-shaped incision to the level of the third rib. After the anterior chest wall was amply resected, the tumor was removed along with the larynx, pharynx, proximal trachea, and esophagus. After an upper abdominal incision was made, we mobilized the entire omentum and the stomach and moved them towards the neck through the posterior mediastinum. A pharyngo-gastric anastomosis was then performed. The omentum was placed around the trachea, the main arteries, and the site of anastomosis. The wound in the neck and anterior chest was closed using one layer, and the end of the trachea was sutured to the skin overlying the resected sterum. Conclusions: We suggest the use of the omentum as a simple and reliable technique in constructing a mediastinal tracheostomy following a total laryngo-esophagectomy for cervicothoracic esophageal cancer.

Key words
mediastinal tracheostomy, omentum, esophageal cancer

Reprint requests
Yoshiyuki Kuwabara Department of Surgery II, Nagoya City University Medical School 1 Kawasumi, Mizuho, Nagoya, 467-8601 JAPAN

Accepted
September 20, 2000

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