The Grillo procedure, involving a laterally bipedicled flap and sternum removal, has historically served as the standard approach for airway reconstruction following salvage resection of cervical esophageal cancer. However, the creation of an anterior mediastinal stoma can result in significant trauma, and subsequent infection may precipitate catastrophic bleeding. The study aimed to evaluate the safety and effectiveness of modified tracheal reconstruction.

We retrospectively analyzed 12 patients with cervical esophageal cancer involving the trachea who underwent chemoradiotherapy at the Shanghai Chest Hospital Esophageal Surgery Department. We developed a novel technique utilizing unilateral pectoralis major myocutaneous flap for tracheal defect reconstruction. Wedge resection of the involved tracheal membrane was conducted to preserve the sternum, opting for a pedicled pectoralis major myocutaneous flap for airway repair. The perioperative clinical data and prognosis of all patients were statistically analyzed.

Twelve patients underwent reconstruction of the posterior tracheal wall using the pectoralis major muscle flap and underwent tracheostomy. Among them, 10 were male and 2 were female, with an average age of 62.6 years. The surgical duration was (5.5±75.7) min, blood loss volume (231.8±44.1) mL, hspitalization stay (23.8 ± 14.1) days, ICU stay (6.7±9.8) days. Four patients experienced severe postoperative complications, including two cases of residual necrosis of the anterior tracheal wall, one case of pharyngogastric anastomotic fistula, and one case of sudden cervical vascular bleeding resulting in death 21 days post-surgery. The remaining patients experienced long-term survival without stoma stenosis or related tracheal stenosis. During follow-up, the Karnofsky Performance Status (KPS) scores at 1-, 3-, and 6-months post-surgery were statistically analyzed. Six patients (50%) scored ≥60 at 3 months post-surgery, and nine patients (75%) scored ≥60 at 6 months post-surgery.

Utilizing a unilateral pectoralis major pedicled myocutaneous flap to reconstruct the posterior tracheal wall proves effective in salvage surgery for cervical esophageal cancer. This improved technique effectively avoids damage to the sternum and surrounding tissues caused by Grillo’s mediastinal stoma, while the rich blood supply of the pectoralis major flap can effectively prevent mediastinal infection and catastrophic bleeding. Unilateral pectoralis major pedicled myocutaneous flap to reconstruct the posterior wall of the trachea is an effective technical in salvage surgery for cervical esophageal cancer.