A modified tracheal transection approach for cervical esophageal lesion treatment: A report of 13 cases

Yang Liu; Nan Huang; Wei Xu; Jie Liu; Changming An; Yiming Zhu; Shaoyan Liu; Zongmin Zhang

doi:10.3389/fsurg.2022.1001488

A modified tracheal transection approach for cervical esophageal lesion treatment: A report of 13 cases

Front Surg. 2022 Oct 21:9:1001488. doi: 10.3389/fsurg.2022.1001488. eCollection 2022.

Authors

Yang Liu¹, Nan Huang¹, Wei Xu², Jie Liu¹, Changming An¹, Yiming Zhu¹, Shaoyan Liu¹, Zongmin Zhang¹

Affiliations

¹ Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.

Abstract

Background: Surgical interventions for tumors in the cervical esophageal region are complicated and laryngeal function is frequently sacrificed. Therefore, we attempted the tracheal transection approach to resect the tumor while preserving laryngeal function.

Methods: Three patients with papillary thyroid cancer (PTC), six with cervical esophageal cancer (CEC), and four with CEC mixed with thoracic esophageal cancer (TEC) were enrolled. The esophagus was exposed after the trachea was transected between the second and third tracheal rings. CEC/TEC: Resection of the esophagus or/and a portion of the hypopharynx with acceptable safety margins and repair with free jejunum or tubular stomach. PTC: Suture the small esophageal incision immediately after removing the tumor. The tracheal dissection was repaired with interrupted sutures throughout the entire layer after the esophageal lesion was resected. The status of the recurrent laryngeal nerve (RLN) determined whether a tracheotomy was necessary.

Results: All 13 patients had effective esophageal lesion excision, with six of them requiring intraoperative tracheotomy. Postoperative complications included a tracheoesophageal fistula (one case, 7.7%), postoperative RLN paralysis (two cases, 15.4%), and aspiration (three cases, 23.1%). Except for two patients with distant metastases, there was no recurrence in the remaining patients after 5-92 months of follow-up.

Conclusion: The tracheal transection approach, as a new surgical technique, can retain laryngeal function while ensuring appropriate exposure and satisfactory surgical resection. Before surgery, the feasibility of this approach must be carefully assessed. The RLN should be protected during the procedure. The operation is both safe and effective, with a wide range of applications.

Keywords: cervical esophageal cancer; papillary thyroid cancer; preservation of laryngeal function; surgical technique; tracheal transection approach.