Outcome of Tracheostomy Closure in Oral Cancer Surgery Patients

Objective: We investigated the outcome of tracheal fistula in patients with oral cancer who underwent tracheostomy at the time of initial surgery.

Study Design: retrospective study

Methods: We retrospectively investigated the outcome of tracheal fistula in 57 patients with oral cancer who underwent tracheostomy. The patients were classified into three groups, which were patients in whom the tracheal fistula closed spontaneously (Group A), patients in whom closure of the tracheal fistula did not occur spontaneously and surgical closure was required (Group B), and patients in whom closure of the tracheostomy could not be achieved (Group C). The following factors were examined for associations with failure of spontaneous closure: patient demographics, primary tumor site, T classification, N classification, stage classification, presence or absence of neck dissection, presence or absence of reconstructive surgery, presence or absence of postoperative (chemo)radiotherapy, presence or absence of postoperative aspiration pneumonia, and duration of tracheal cannula placement.

Results: Among the 57 subjects, Group A were 27 (47.4%), Group B were 23 (40.4%), and Group C were 7 (12.3%). In Group B, surgical closure with a hinge flap was performed in all 23 patients. We found that neck dissection and postoperative (chemo) radiotherapy were both factors that had an independent influence on whether closure of the tracheostomy could be achieved.

Conclusion: Although early removal of the tracheal cannula is advantageous for improving the QOL of the patient, long-term cannulation does not interfere with spontaneous closure. Accordingly, it is necessary to carefully consider the timing of decannulation.