[Superior mediastinum exposure in the removal of the advanced cancers in the lower neck regions].

Objective: In order to achieve the radical removal of advanced cancers involving the lower neck regions.

Methods: Upon the thorough evaluation of tumors with different imaging methods, several kinds of superior mediastinum exposure were carried out in a series of 18 patients with advanced neck cancer of various kinds. There were 10 cases of stomal recurrence, 2 cases of recurrent thyroid carcinomas, 2 cases of advanced carcinomas in the cervical trachea, and 4 cases of metastatic carcinomas in the supraclavicular region. According to the site and extension of tumor invasion, simple manubrium resection were performed in 10 cases, resection of the medial half of the clavicle was adopted in 4 cases and resection of the manubrium and the medial 1/3 of both clavicles were used in 4 cases. Pectoralis major myocutaneous flaps were raised to reconstruct the defects resulting from tumor ablations.

Results: Radical removal of tumors was achieved in 16 cases. Minor complications occurred in 3 cases including one case of intraoperative pneumothorax and 2 cases of postoperative pharyngeal fistula. One patient developed aneurysm in the right common carotid artery after radical neck dissection and wound infection. One patient died of eruption of the innominate artery due to the major vessel injury caused by the tracheostomy tube two months after the operation. Results from postoperative follow-up demonstrated that one-year, two-year and three-year postoperative survival rate was 72.2% (13/18), 22.2% (4/18) and 11.1% (2/18), respectively, in this series.

Conclusion: Superior mediastinum exposure is a necessary and reliable surgical approach in the removal of advanced tumors involving the lower neck and superior mediastinum.