Tracheal resection and mediastinal tracheostomy for cervical parastomal recurrence after laryngectomy and radiochemotherapy followed by several complications: a rare case report

BACKGROUND: Patients with parastomal recurrence have poor prognosis and pose a great challenge to the surgeons. Surgical resection is the only curable choice. Treating this patient group with a patent tracheostoma and a stable airway is the main objective. CASE PRESENTATION: We present an extremely rare case of a parastomal relapse after laryngectomy and radiochemotherapy for laryngeal carcinoma. Partial resection of the manubrium, medial part of the right clavicle, medial parts of the 1st and 2nd ribs, proximal part of the trachea below the cervical tracheostomy and subtotal thyroidectomy were performed. For reconstruction around the mediastinal tracheostomy Conley-Sisson right thoracoacromial myocutaneous pectoral "nipple" flap was carried out. The patient complicated with skin dehiscence and necrosis and spontaneous pharyngo-esophageal fistula. A retrosternal omentoplasty of the fistula and a feeding gastrostomy were successfully executed, followed by closure of the skin defect at the base of the neck above omentoplasty by means of a free split thickness skin graft from the left anterior thigh region and degastrostomy. CONCLUSIONS: Surgical treatment of laryngeal carcinoma recurrence in the region of tracheostomy is a feasible and promising way for prolonging patients' life. This extremely rare case presents an evidence of the primary sole of surgery in the treatment of laryngeal carcinoma parastomal relapse.