Evolving roles of anterior mediastinal tracheostomy in head and neck oncology

Introduction: The role of surgery in head and neck oncology has evolved in the era of multimodality treatment, with radical procedures increasingly performed in both primary and salvage settings. Anterior mediastinal tracheostomy (AMT) remains one of the most challenging operations for locally advanced malignancies; however, contemporary evidence regarding its clinical indications and outcomes is limited. Materials and methods: A nationwide multicenter retrospective study involving six high-volume institutions was conducted to evaluate the current role, safety, and oncologic outcomes of AMT. Eighty-six patients who underwent AMT between 2000 and 2017 were analyzed. Clinicopathological characteristics, perioperative complications, treatment-related mortality, and survival outcomes were assessed. Results: Of the 86 patients, 62 underwent AMT for primary disease and 24 for recurrent disease. Among the primary cases, 53 underwent upfront surgery, whereas 9 received preoperative therapy. Patients with recurrent disease or prior treatment exposure exhibited higher perioperative risk. Perioperative complications occurred in 76.7% of patients, with treatment-related mortality observed in 10.5% and hospital deaths in 8.1%. The 3- and 5-year overall survival rates were 36.6% and 30.4%, respectively, with a median survival of 22.1 months. Overall outcomes may suggest improvement compared with historical reports. Conclusions: AMT currently serves a dual role as both primary radical surgery and salvage intervention, although prior treatment is associated with increased risk. Advances in reconstruction and perioperative management may have contributed to improved outcomes; however, ongoing organ-preservation strategies are likely to shift AMT indications toward salvage or conversion settings. These findings support careful patient selection and multidisciplinary evaluation when considering the evolving role of AMT in contemporary head and neck oncology.