Radiologic and surgical evidence of pre-tracheal anatomies and implications for safe procedures in elderly oncologic patients: implications for elective or emergent tracheotomies

Abstract

Abstract Background To assess the anatomical relationship and age-related variability of the anatomies in the pre-tracheal space in elderly patients with head and neck cancers and to guide tracheotomy with clinical evidence for either planned or improvised procedures. Methods From January 2019 to February 2022, hospitalized head and neck cancer patients aged over 65 years (127 cases) and under 65 years (74 cases) were enrolled in this study as the observation and the control groups, respectively. All these patients received contrast-enhanced CT scans, ablative operations and tracheotomies for primary head and neck cancers. The radiographic reconstructions of vascular morphologies were compared, focusing on three target vessels: anterior jugular veins (AJVs), innominate arteries (IAs) and inferior thyroid plexuses (ITVPs). The upper locations of the isthmus, and the largest diameters of thyroid glands were compared as well. In addition, surgical exposure of those vessels was recorded during tracheostomies to verify these radiologic findings. The tracheotomy procedure-related complications were also compared. Results A total number of 201 patients (115 males and 86 females) were identified in this study. The mean age of the elderly group reached 72.0 years (range: 65–87 years), most of whom (41.7%) were with oral or oropharyngeal cancer. The proportion for single-branch type AJVs in the elderly group (11.9%) was higher than that in the young counterpart (8.2%), though no statistical difference was found (P = 0.701). Radiologically speaking, the IAs were categorized as the low-bifurcation (104 cases, 51.7%), high-bifurcation (n = 37, 18.4%), high-platform (27, 13.4%), low-platform (30, 14.9%) and variant types (3, 1.5%). Age-related changes of IA types were found between the elderly and the young groups (P < 0.01), especially for the platform IAs which might interfere with tracheal exposure. This phenomenon was also closely related to the intraoperative tracheotomy findings (rn=0.59, P < 0.01). Besides, for the ITVPs, the common-trunk types were mostly found in the elderly group (40%). Conclusions Considering the age-related changes, the evaluation of the pre-tracheal anatomies based on radiographic evidence can facilitate safer tracheotomies in elderly patients. Besides, implications for impromptu tracheotomies may also be drawn with knowledge of these variable anatomies.