[Radical surgery for cervical esophageal cancer involving the tracheal membranous part and its reconstruction].

Objective: To investigate the feasibility of radical surgery for cervical esophageal cancer (CEC) invading the membranous part of the trachea and the optimal strategies for posterior tracheal wall reconstruction. Methods: A retrospective analysis was conducted on the clinical data of 7 patients with CEC invading the membranous part of the trachea who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from March 2020 to March 2024. All 7 patients were male, with an age range of 49 to 69 years. Two cases were primary CECs involving the cervical tracheal membranous part; three cases were recurrent CECs after chemo-radiotherapy involving the tracheal membranous part, among which two had tracheoesophageal fistula (TEF); one case developed TEF after esophageal replacement with a gastric tube following CEC surgery; and one case was recurrent CEC involving the tracheal membranous part and complicated with TEF after surgery. All cases were discussed by a multidisciplinary team (MDT) to determine the optimal treatment plan. This study focused on the surgical plan design, posterior tracheal wall reconstruction techniques, and therapeutic efficacy. Results: All 7 patients successfully underwent tumor resection and posterior tracheal wall reconstruction. Four cases which underwent total laryngectomy, total hypopharyngectomy, and total esophagectomy were reconstructed by gastric tubes and pectoralis major myocutaneous flaps, using supraclavicular artery island flaps or strap muscle flaps to reconstruct the posterior tracheal wall. One case retained laryngeal function after gastric tube reconstruction and repairment of the membranous part of the trachea with a strap muscle flap. Two cases with postoperative TEF were repaired with vascularized flaps (one repair failed and the patient subsequently underwent stent implantation). The follow-up period ranged from 12 to 58 months, with five patients surviving free of recurrence and two patients dying at 25 and 42 months postoperative, respectively. The success rate of tracheal reconstruction was 100%, and six patients resumed oral feeding. Conclusion: Performing gastric tube reconstruction combined with vascularized tissue flaps (such as supraclavicular artery island flaps or strap muscle flaps) for primary reconstruction of the posterior tracheal wall is a safe, feasible, and effective radical strategy for treating CEC invading the tracheal membranous part.