Thorascopic staging of stomal recurrence

Mark Wax, J. D. Garnett, G. Graeber, R. S. Weber

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background. Squamous cell carcinoma of the low cervical area may be secondary to stomal recurrence following laryngectomy, low cervical esophageal disease, or peritracheal metastasis. Most often patients with disease in this area have already received both surgery and radiotherapy. Prior to Sisson's description of the trans-sternal radical neck dissection or mediastinal dissection the management and prognosis was uniformly poor. Since then, a number of authors have reported their experience with mediastinal dissection. Survival remains poor but palliation has been acceptable. Unfortunately, resectability of the disease cannot often be determined prior to the actual surgical procedure. A number of patients are explored only to have the procedure terminated. Thoracoscopy is a procedure that involves insertion of two or three trocars into the right thoracic cavity with collapse of the right lung. A form of endoscopic surgery, it permits visualization and dissection of the important structures of the mediastinum. Tracheal, esophageal, and great vessel invasion by tumor can be evaluated. Methods. Prospectively, all patients initially seen with stomal recurrence from 1991 to 1994 were evaluated. CT scans. MRIs as well as thoracoscopy were performed when indicated. Results. One patient required conversion to a minithoracotomy involving a 7-cm chest incision. The patient was found to have unresectable disease with tumor involving the great vessels of the mediastinum. A second patient was found to have unresectable disease with tumor encasing the subclavian artery. The third patient was found to have no mediastinum involvement. The patient with no mediastinum involvement underwent a stomal resection with mediastinal dissection. Reconstruction with a pectoralis major myogenous flap was performed. The patient has remained disease free to date. The remaining two patients were judged to have unresectable disease and were offered palliative treatment. Both of these patients died of the disease within 6 months. Conclusions. Thoracoscopy provides important information in judging the surgical resectability of patients with stomal recurrence. This procedure has not been previously described in the otolaryngologic literature. We provide some suggestions for its use in the evaluation of the mediastinal extent of disease.

Original languageEnglish (US)
Pages (from-to)409-413
Number of pages5
JournalHead and Neck
Volume17
Issue number5
StatePublished - 1995
Externally publishedYes

Fingerprint

Recurrence
Mediastinum
Thoracoscopy
Dissection
Mediastinal Diseases
Esophageal Diseases
Thoracic Cavity
Neoplasms
Laryngectomy
Subclavian Artery
Neck Dissection
Pulmonary Atelectasis
Palliative Care
Surgical Instruments
Squamous Cell Carcinoma
Radiotherapy
Thorax
Neoplasm Metastasis
Survival

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Wax, M., Garnett, J. D., Graeber, G., & Weber, R. S. (1995). Thorascopic staging of stomal recurrence. Head and Neck, 17(5), 409-413.

Thorascopic staging of stomal recurrence. / Wax, Mark; Garnett, J. D.; Graeber, G.; Weber, R. S.

In: Head and Neck, Vol. 17, No. 5, 1995, p. 409-413.

Research output: Contribution to journalArticle

Wax, M, Garnett, JD, Graeber, G & Weber, RS 1995, 'Thorascopic staging of stomal recurrence', Head and Neck, vol. 17, no. 5, pp. 409-413.
Wax M, Garnett JD, Graeber G, Weber RS. Thorascopic staging of stomal recurrence. Head and Neck. 1995;17(5):409-413.
Wax, Mark ; Garnett, J. D. ; Graeber, G. ; Weber, R. S. / Thorascopic staging of stomal recurrence. In: Head and Neck. 1995 ; Vol. 17, No. 5. pp. 409-413.
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