Urgent and emergency tracheostomy in head and neck cancer: practical guide from the Brazilian Society of Surgical Oncology (SBCO)

OBJECTIVE: Propose a structured decision-making model for the indication of urgent and emergency tracheostomy in patients with head and neck tumors, integrating clinical warning signs, functional airway assessment, and contextual factors, thereby promoting timely indication of the procedure and reducing the morbidity and mortality associated with delayed emergency interventions. METHODS: This guideline was developed through consensus by the Head and Neck Neoplasms Commission of the Brazilian Society of Surgical Oncology (SBCO). A systematic critical review of the literature was conducted using the MEDLINE and SciELO databases, prioritizing studies with high or moderate levels of evidence. Recommendations were formulated and classified according to the GRADE system, reflecting both the strength of recommendation and the quality of available evidence, with adaptation to the Brazilian healthcare context. RESULTS: Recommendations are presented based on an integrated assessment of clinical, endoscopic, and contextual criteria for the indication of urgent and emergency tracheostomy. Particular emphasis is given to the concept of a "window of opportunity" before airway collapse, the preferred use of awake tracheostomy under local anesthesia in patients at substantial risk of acute airway obstruction, prioritizing awake endoscopic intubation in anaplastic thyroid carcinoma, and the careful strategic selection of the tracheostomy level in laryngeal neoplasms, considering subsequent oncologic surgical treatment. CONCLUSION: An anticipatory, integrated, and strategically planned approach to tracheostomy indication in patients with head and neck tumors may reduce catastrophic respiratory events, preserve the oncologic treatment pathway, and improve patient safety, despite the limitations inherent to the currently available evidence.