Tracheal resection and reconstruction: A 3-year case series of 14 patients (original) (raw)
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Current Challenges in Thoracic Surgery
Background: Tracheal surgery is still a challenge for thoracic surgeons, owing to the anatomical features, the relative rarity and the technical troubles of surgery of this airway tract. We report our experience over the past 30 months. Methods: From February 2017 to August 2019, the prospectively collected clinical data of 22 patients who underwent surgery for idiopathic laryngotracheal stenosis (ILTS), post-intubation laryngotracheal and tracheal stenosis, tracheal cancers, tracheoesophageal fistulas (TEF) and post-traumatic tracheal lacerations were reviewed and outcomes evaluated. Results: The mean age of the population was 54 (range, 21-83) years. Fourteen (63.6%) patients were male. Thirteen (59.1%) patients presented a laryngotracheal involvement, while 9 (40.9%) patients had a tracheal disease localization. Surgical procedures were: 10 (45.5%) Pearson modified subglottic laryngotracheal resection and reconstruction (LTRR) according to Liberman-Mathisen, 3 (13.6%) tracheal resection with primary anastomosis, 3 (13.6%) single-stage tracheal resection and reconstruction (TRR) with direct esophageal closure, 3 (13.6%) direct suture of tracheal defect according to Angelillo-Mackinlay, 2 (9.1%) Grillo laryngotracheal resection with Liberman-Mathisen plasty and 1 (4.5%) thyroidectomy combined to Pearson modified subglottic laryngotracheal reconstruction according to Liberman-Mathisen for laryngeal infiltration from thyroid cancer. The mean length of the resected trachea was 32.17±6.15 mm. Six (27.3%) patients developed postoperative complications. Perioperative mortality was 4.5% (1 patient). No patient had tumour recurrence or recurrent stenosis. The mean follow-up time was 19.68±10.17 months. One-year and 2-year overall survival (OS) was 95% and 80%, respectively. Post-operative complications and OS were not significantly correlated to site of disease, length of tracheal resection or type of surgery. Conclusions: Tracheal surgery appears feasible, safe and effective, even in the most challenging subset of laryngotracheal resections, allowing excellent long-term outcomes. However, it should be performed in specialized, high-volume centres, by experienced surgeons, and a careful preoperative patient assessment is mandatory.
State of the art in tracheal surgery: a brief literature review
Multidisciplinary Respiratory Medicine, 2018
Background: Tracheal surgery requires a highly specialized team of anesthesiologists, thoracic surgeons, and operative support staff. It remain a formidable challenge for surgeons due to the criticality connected to anatomical considerations, intraoperative airway management, technical complexity of reconstruction, and the potential postoperative morbidity and mortality. Main body: This article focuses on the main technical aspects and literature data regarding laryngotracheal and tracheal resection and reconstruction. Particular attention will be paied to anastomotic and non-anastomotic complications. Short conclusion: Results from literature confirm that, when feasible, laryngotracheal and tracheal resection and reconstruction is the treatment of choice in cases of benign stricture and malign neoplasm. Careful patient selection, operative planning, and execution are required for optimal results.
Sixty tracheal resections - single center experience
Interactive CardioVascular and Thoracic Surgery, 2008
This study evaluates the clinical outcome following surgery of our patients for the last seven years. Between 2001 and 2008 we performed tracheal resections in 60 patients. There were 46 cases of postintubation stenosis and 14 tumors. The range of resected rings was 1-8. The maximal resection length performed in our series (4 cm) was achieved using only basic releasing maneuvers such as anterior dissection of the trachea and cervical flexion. Emergency tracheal resection with no complications was performed in 12 patients who presented with severe dyspnea due to very tight stenosis. One patient died during the surgical intervention from a stroke. There were two postoperative deaths, both in patients with tracheo-esophageal fistula. As major complications we mention one patient with restenosis who underwent revision surgery. Among the patients with malignant tumors we had one local epidermoid carcinoma recurrence 18 months after surgery and the two patients with thyroid cancer who died six and nine months later. Basic releasing maneuvers allow a good length of the trachea to be resected with no complications. We consider that emergency tracheal resection can be performed with success. Squamous cell carcinoma was the most frequent histological type in our series.
Tracheal and laryngotracheal resections and reconstructions—a single-centre experience
Journal of Thoracic Disease
Background: Surgical resection has proven to be the most effective long-term treatment in managing airway stenoses and has shown to decrease the risk of tumor recurrence and mortality in patients with tumor infiltration to the airways. However, there are only a few Nordic reports on the results of a tracheal resection (TR) and cricotracheal resection (CTR). This study aimed to evaluate the volume and short-term outcome of TR and CTR at our institution.
Thoracic surgery clinics, 2014
There is no universally valid definition of the extent of tracheal resections that would be considered "extended." Underlying disease, necessary length of resection, anatomic localization, and chosen surgical approach account for a manifold interdependency. Existing data suggest a "cutoff margin" of 4 cm or more, referring to the likelihood of complications and necessity of additional mobilization maneuvers. This overview outlines worldwide experiences and the surgical variety of possibilities, as well as their execution and appropriate use.
Our comprehensive experience with tracheostomy in tertiary multi-speciality hospital over four years
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: Tracheostomy is a common surgical procedure used to achieve a secure airway in patients in elective as well as emergency conditions. Our study accounts for our first-hand experience with the procedure in our tertiary multi-speciality hospital.Methods: It is a four year (January 2017 to February 2021) retrospective study in which all the 246 cases of tracheostomies were taken into account which were performed during this study period in the department of otorhinolaryngology (ENT), Surat Municipal Institute of Medical Education and Research (SMIMER), Surat (India). The patients were thoroughly followed up until the final outcome of the tracheostomy was established. Results: A total of 246 tracheostomies were performed, 63.82% of which were in men. The mean patient age was 42 years. The majority (76%) were elective, performed for various indications, while the remaining 24% were emergency tracheostomies. All tracheostomies were performed by otorhinolaryngologists. Complica...
An Interdisciplinary Approach to the Management of Individuals with Tracheostomy
Respiratory Care
Background Study objectives were to identify the proportion of tracheostomy subjects with successful decannulation, time to decannulation after intensive care unit (ICU) discharge, and predictors of long-term tracheostomy based on an interdisciplinary team approach. Methods This retrospective cohort study recruited all adult tracheostomy subjects admitted between January 2016 and December 2018. Long-term tracheostomy subjects with recurrent admissions and compromised airway, and subjects with neck tumors obstructing the airway were excluded. Data regarding subjects' demographics, comorbidities, Glasgow Come Score (GCS), feeding, ICU discharge date, decannulation date, and outcome were collected. The interdisciplinary team members included tracheostomy resource nurse, respiratory therapist, speech clinician, Ear, Nose, and Throat (ENT) specialist, and Rehab medicine specialist. Results Of the 221 subjects followed during the study period, 16% (36/221) were excluded, and the remaining 84% (185/221) underwent the decannulation protocol. Subjects who failed capping multiple times 114/185 (62%) were labeled long term and did not progress to decannulation. We successfully decannulated 71/185 subjects (38%), and none of them developed decannulation failure. Forty deaths occurred during hospitalization, but none was due to tracheostomy complications. The median time to decannulation after ICU discharge was 47 days. Predictors of long-term tracheostomy were GCS <11 (odds ratio [OR], 5.6; 95% CI, 2.7-12), age ≥65 years
Tracheal sleeve pneumonectomy: Long-term outcome
Lung Cancer, 2006
Selected primary lung cancers less than 2 cm from the carina or invading the tracheo-bronchial angle, formerly considered inoperable, can be amenable to tracheal sleeve pneumonectomy (TSP). Such a delicate technique, can entail remarkable post-operative morbidity and mortality, and only few clinical series are reported. Purpose of this paper is to examine complications and long-term survival of our personal series and those reported in literature. At our academic department from 1983 to December 2004, out of 99 patients with NSCLC less than 2 cm from the carina, 35 (35.4%) were deemed inoperable after conventional staging; the remaining 64 underwent surgery. Since 1993 in every patient with lung cancer we perform a thoracoscopic exploration as the first step of the intervention. Unexpected causes of inoperability were found at thoracotomy in nine patients (14.1%) and at thoracoscopy in two other patients. Of the remaining 53 patients, 52 had a right TSP and one a left TSP. Intraoperative mortality was nil. Perioperative mortality was 7.5%. Major complications occurred in 11.3% of the patients. Thirty (56.6) patients are alive and disease-free 23-97 months after surgery; for 18 (33.4%) of these, more than 5 years have elapsed after the operation. TSP is the only concrete option for treating lung cancer originating less than 2 cm from the carina. The review of our experience and of other reported series suggests that, with careful selection of patients and meticulous surgical technique, operative mortality and complications are acceptable. Long-term survival and prognosis are encouraging.
Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies
Anaesthesia, 2012
Adult tracheostomy and laryngectomy airway emergencies are uncommon, but do lead to significant morbidity and mortality. The National Tracheostomy Safety Project incorporates key stakeholder groups with multidisciplinary expertise in airway management. , the Intensive Care Society, the Royal College of Anaesthetists, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care and the National Patient Safety Agency. Resources and emergency algorithms were developed by consensus, taking into account existing guidelines, evidence and experiences. The stakeholder groups reviewed draft emergency algorithms and feedback was also received from open peer review. The final algorithms describe a universal approach to managing such emergencies and are designed to be followed by first responders. The project aims to improve the management of tracheostomy and laryngectomy critical incidents.