223. OUR SURGICAL TECHNIQUE OF TRACHEAL RESECTION AND ANTERIOR MEDIASTINAL TRACHEOSTOMY (AMT) IN THE MULTIDISCIPLINARY TREATMENT OF ESOPHAGEAL CANCER INVADING TRACHEA

Abstract Combined tracheal resection and anterior mediastinal tracheostomy (AMT) for esophageal cancer with tracheal invasion is a challenging treatment and technically demanding. Herein, we introduce our surgical procedure of AMT and its tips to reduce postoperative complications. Briefly, in a supine position with cervical approach, the manubrium, the medial half of the clavicle, and the adjacent first and second ribs on both sides were removed to achieve an open cervico-thoracic view. After completion of tumor resection, AMT was performed; after encircling brachiocephalic artery and transected innominate vein if needed, the tracheal stoma was translocated from the left to right side of the brachiocephalic artery to avoid postoperative hemorrhage caused by tracheal compression. In a case of free-jejunum reconstruction, we usually harvest mesentery as much as possible to fill in the surrounding dead space in the upper mediastinum around trachea and major arteries to prevent infection (we also use the pectoral myocutaneous flap and omentum for this purpose). The tracheal stoma was finally created using interrupted stitched to attach the tracheal stump to the native chest skin. https://photos.google.com/photo/AF1QipNDuxhBpSYDIDydLYD_0Vk917Kd13bG5t6ILtb6