Tumor Recurrence at the Tracheostomy Stoma Following Oncologic Surgery for Squamous Cell Carcinoma of the Tongue: A Case Report and Literature Review

Tumor recurrence at the stoma of a temporary tracheostomy is an uncommon but serious complication of surgical treatment for head and neck squamous cell carcinoma.We report the case of a 52-year-old farmer, former smoker (3.75 pack-years), with tongue squamous cell carcinoma initially managed at another institution with two partial glossectomies and an oncologically insufficient result.He underwent compartmental glossectomy, bilateral modified radical neck dissection, tracheostomy performed before tumor resection, and microvascular reconstruction with an anterolateral thigh flap; pathology confirmed pT4aN0M0 with negative margins and no metastatic involvement in any of the 91 examined lymph nodes, and he received adjuvant radiotherapy without concomitant chemotherapy.During the last week of adjuvant radiotherapy, approximately 16 weeks after surgery, a rapidly progressive vegetant lesion appeared around the tracheostoma; biopsy confirmed poorly differentiated squamous cell carcinoma recurrence at that site, not amenable to surgical salvage due to the extent of the disease and involvement of adjacent structures.The patient subsequently developed tracheitis, aspiration pneumonia, and tumor progression, with severe functional decline and exclusive palliative care until death.Notably, this recurrence occurred in the absence of histopathologically demonstrable nodal disease and became clinically evident during radiotherapy.Mechanical tumor seeding is a plausible explanatory mechanism, particularly when tracheostomy precedes tumor resection, although a definitive causal relationship could not be established.Any vegetant, indurated, ulcerated, or hemorrhagic lesion arising at a tracheostomy stoma in a patient with a history of head and neck squamous cell carcinoma should prompt targeted oncologic evaluation and, when appropriate, histopathological confirmation.Whether considering the anatomic relationship between the tracheostomy site and the irradiation volumes in selected patients can reduce this risk remains to be determined.Further studies are needed to clarify the true role of tumor implantation and to determine whether specific modifications in surgical technique or radiotherapy planning can reduce the risk of this rare but serious complication.