Stomal recurrence invading the cervicothoracic esophagus and upper mediastinum: resectability and the creation of a safe anterior mediastinal tracheostoma.

Surgical salvage for stomal recurrence is a for midable problem for head and neck surgeons. The two factors of considerable significance are resectability and establishment of a safe anterior mediastinal tracheostoma. A case of stomal recurrence invading the cervicothoracic esophagus and upper mediastinum is presented. Total esophagectomy and upper mediastinal dissection was performed. The esophagus was reconstructed immediately with a pedicled gastric flap. The omentum on the gastric pedicle was wrapped around the trachea to reduce the likelihood of erosion into the great vessels and to supplement the lateral blood supply to the trachea. No serious postoperative complications were observed. We believe that the total esophagectomy improved the resectability, and that the bulk of the gastric pedicle and the use of the omentum prevented significant postoperative complications associated with an anterior mediastinal tracheostoma.