Indication of tracheostomy for advanced oral or mesopharyngeal cancer resection

Abstract

In advanced oral or mesopharyngeal cancer requiring reconstruction, preventive tracheostomy have been performed to insure an airway postoperatively. However, tracheostomy often causes difficulty in swallowing and stress in the postoperative period for the patients. We have devised a strategy to avoid tracheostomy as much as possible in the cases requiring reconstruction except for the cases with over 2/3 resection of the base of the tongue or with prospective difficulty of re-intubation. Eleven cases were treated without tracheostomy out of 20 cases operated on with reconstruction in our hospital from 1995 through 1997. These patients were managed under nasal intubation for less than 2 days on average with careful observation postoperatively. In 11 non-tracheostomized cases, 1 case experienced venous thrombosis of a free flap and tracheostomy was performed at the salvage operation. Other 10 non-tracheostomized case were compared with 10 tracheostomized cases who were treated from 1991 though 1995. It was revealed that non-tracheostomized cases tended to have shorter periods until they could speak or eat, and also have a shorter postoperative admission term. In these cases, we have not experienced serious complications such as aspiration pneumonia or dyspnea, instead, special care in the postoperative period was needed. Thus, certain advanced cases who undergo curative resection followed by reconstruction can be managed without tracheostomy. The indication of tracheostomy in surgery for oral or mesopharyngeal cancer should be decided carefully.