Application of low anterior mediastinal tracheostomy for locally advanced cervicothoracic esophageal cancer undergoing total laryngopharyngoesophagectomy: a case report

A sixty-six year-old woman came to hospital, complaining of dysphagia and weight loss. Esophagoscope showed a neoplasm between 15 and 20 cm from the incisors, biopsy revealed esophageal squamous cell carcinoma. Chest computed tomography (CT) showed that the cervical esophageal wall became thicker, the narrowing of the lumen extended downwards to the upper thoracic esophagus. Tumor invaded the membranous parts of the 5th to 12th rings of the trachea, and no swollen lymph nodes were observed in the mediastinum. The clinical stage was cT4N0M0 with borderline resectable possibility. The patient was assessed with stable disease after receiving two courses of neoadjuvant chemotherapy using DTX/CDDP/5-FU strategy. After a standard multidisciplinary treatment evaluation, total laryngopharyngoesophagectomy plus low anterior mediastinal tracheostomy (AMT) was performed. To ensure radical resection, we innovatively adopted the application of Double S-shaped myocutaneous flaps, which helps to extend the trachea and facilitate the stoma. Meanwhile, we removed the upper sternum, sternum stem, clavicle head and first and second costal cartilage to facilitate the tracheostomy and reduce the space around the stoma to avoid fluid accumulation. The pathological result showed pT4bN0M0 stage with partial response after neoadjuvant chemotherapy. This patient developed a minor anastomotic leakage which was effectively managed. Finally, she was discharged successfully 21 days after surgery.