Surgical considerations for tracheostomy recurrence

After total laryngectomy for laryngeal cancer, if suspicious changes such as lumps, ulcers, and infections appear around the patient's tracheostomy, it is likely that there is recurrent cancer at the tracheostomy and must be treated with caution. The surgical precautions are as follows.

Surgical indications and contraindications:

1. Type I and II tumors are most suitable for surgical treatment because the lesions are limited in scope and do not involve important structures, so extended resection and radical cure are possible.

2. For type III and IV tumors, since neck dissection has been performed during laryngeal cancer resection, the internal jugular vein has been removed, and the area around the carotid artery has been dissected and separated, preoperative ultrasound, CT, etc. show that the tumor has surrounded the carotid artery. In this case, the arterial wall has often been eroded by the cancer and is difficult to separate during further surgery. Even if it is separated with difficulty, there is a high chance of residual cancer, and surgery needs to be carefully considered.

3. Surgery is contraindicated for patients with poor general condition, suffering from serious diseases such as diabetes, heart disease, hypertension, etc., who have undergone multiple surgeries and radiotherapy before surgery, or who have difficulty healing after surgery.

4. For patients with subglottic invasion of the primary cancer, subglottic tumors, or N2 or N3 cervical lymph nodes, surgery should be carefully considered.

Tips: Classification criteria for tracheostomy recurrence

Type I: The recurrent tumor is confined to the upper part of the stoma, and the prognosis is good;

Type II: recurrence above the stoma, with invasion of the esophagus. If the invasion is limited, the prognosis is good;

Type III: recurrence at the lower part of the stoma and extension to the mediastinum. It can be relieved after treatment but the prognosis is poor;

Type IV: recurrence at the lower part of the stoma and extension to the subclavian, substernal, and bilateral areas. It can be relieved after treatment but the prognosis is usually poor.