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 follow-up of patients was 1 month (range 0–86). No tracheotomy-related 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.