Tracheotomy in Cancer Patients: Experience from a Cancer Hospital in Pakistan

Abstract

Tracheotomy is commonly performed for the management of upper airway compromise. Trauma and head and neck cancers are the most frequent indications. The objective of this study was to share our experience with tracheotomy performed for a broad range of malignancies including but not limited to head and neck cancer. This study is a retrospective case series of patients who underwent tracheotomy from January 2004 to June 2012 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. A total of 130 patients were included in the study. Patient demographics, indications for tracheotomy, underlying malignancy, and duration of follow-up were assessed. Main indications were elective (prolonged intubation and/or as a prerequisite for head and neck cancer surgery) and emergency (stridor). Outcome was assessed on a basis of successful decannulation and complications related to tracheotomy. Indications for tracheotomy were elective in 55 (44.7 %) and emergent in 75 (55.3 %) patients. Most common underlying malignancy was leukemia/lymphoma in 38 (29.2 %) patients. There were seven (5.3 %) complications in emergency tracheotomies including bleeding in three, emphysema in two, and dislodgement and infection in one patient each. In the elective setting, three (2.3 %) complications were observed with dislodgement in one and stomal stenosis in two patients. Decannulation was successfully carried out in 23 (18 %) patients. Median followup of patients was 1 month (range 0-86). No tracheotomyrelated mortality was observed. Tracheotomy was performed with relative safety in cancer patients, but low rate of successful decannulation predominantly due to persistent nature of disease.

Outcomes of Patients Undergoing Emergency Tracheostomy During COVID 19 Pandemic: Our Experience from a Tertiary Care Centre in North-East India

“…The commonest indication for tracheostomy in our study was hypopharyngeal cancer [45.2%] (Table 3 ). This is in contrast to other previous studies that however reviewed tracheostomies done for various other pathologies and different study populations [ 8 , 9 ].…”

“…Tracheostomy is a surgical procedure that entails making an opening into the trachea and maintaining same with a tube to establish communication with the exterior, [ 7 ] the major aim of which is circumventing upper airway obstruction. The most frequent recorded indications for tracheostomy in literature are trauma and head and neck cancers [ 8 , 9 ]. In these situations, it is done to relieve upper airway obstructions (either as emergency or elective procedures).…”

Complications of Tracheostomy and Leading Factors Among Patients Presenting at a Tertiary Care Hospital, Karachi

“…It has been debatable that who should be the ideal person in the hospital setting to perform this procedure. ENT specialist, anesthetist, critical care experts and emergency physicians have been performing this procedure in routine in all parts of the world [11][12][13] . Critical care and emergency medicine are toddler as specialties in our part of the world so most of the burden has been shared by ENT experts and anesthetist for performing the tracheostomy in our setup.We conducted this study mainly on the tracheostomies performed by ENT specialist in all the settings of our hospital in order to assess the complications of this procedure and factors correlated with presence of these complications at our tertiary care teaching hospital of Pakistan Navy.…”

“…This cross-sectional study was conducted at the ENT, Emergency and Critical Care Unit of PNS Shifa Hospital Karachi (IREB letter no: 002) from Apr to Oct 2019. As it is not a very common procedure, so study was done by case series design and all cases which reported during the study time were included in the analysis 11,12 . Sample was gathered by using universal sampling technique.…”

Post-Traumatic Distress and Symptom Experience in Patients With Head and Neck Cancer–Related Tracheostomy and Family Caregivers

“…in 47% of tracheostomies for patients with cancer, the patients had HNC; in addition, more than half of HNC-related tracheostomies could not be decannulated because of the need for permanent tracheostomy (8%) or progressive malignancy (49%) (Bhatti et al, 2015). The postoperative complication rate with tracheostomy ranges from 3.2% to 31%, and complications include hemorrhage, tracheal stenosis, mucus plugs, fistula, infection, and dislodgement (Bhatti et al, 2015;Fattahi et al, 2012;Shah et al, 2012;Straetmans et al, 2010).…”