State of the art in tracheal surgery: a brief literature review (original) (raw)
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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.
Tracheal resection and reconstruction: A 3-year case series of 14 patients
The Medical journal of Malaysia, 2022
Introduction: Tracheal resection and reconstruction is one of the most challenging procedures and is seldom performed due to its complexity. Despite being a life-saving procedure, only a handful of centres are performing this procedure in Malaysia. We report our 3 years’ experience in Hospital Kuala Lumpur performing tracheal resection and reconstruction in 14 patients. Materials and Methods: Retrospective review of medical records of tracheal resection and reconstruction was performed from September 2018 till August 2021. Data that were extracted include demographic information, indication for surgery, intraoperative airway management, surgical approach, perioperative parameters, complications, and 1- year outcome. Results: Fourteen patients with the mean age of 49.1 years underwent tracheal resection and reconstruction, consisting of 9 benign and 5 malignant diseases. Non-intubated airway approach was used in three patients. Transcervical surgical access was used in 10 patients whereas thoracotomy, video- assisted thoracoscopic surgery, and combination of thoracotomy, transcervical incision with manubrial split were used in 3 patients respectively. The mean length of trachea resected was 2.3cm, with the longest length of 4.5cm. All patients were extubated post-operatively except for one due to traumatic brain trauma. No anastomosis dehiscence was seen. We also did not see any post- operative stenosis and all the patients are alive. Conclusion: Tracheal resection and anastomosis can be performed safely in complex stenosis and malignant tumours. Pre-operative planning with a multidisciplinary approach is vital to ensure a good outcome.
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.
Tracheal resection and anastomosis
Operative Techniques in Otolaryngology-Head and Neck Surgery, 1997
Management of laryngotracheal stenosis remains one of the most challenging problems facing the otolaryngologist. Decannulation is the primary treatment goal, and multiple options are available. These include dilations, endoscopic removal of the obstruction, and open surgical techniques. No single procedure is appropriate for all situations, and the surgeon must choose the operation best suited for every particular case. This article describes the technical details and indications for tracheal resection and end-to-end anastomosis, emphasizing the releasing procedures that can be used in the management of extensive tracheal stenosis. The special problems created by subglottic stenosis and their open surgical management are also addressed.
Tracheal Resection Anastomosis: A Retrospective Analysis of 33 Cases
Innovations in Surgery and Interventional Medicine
Introduction Laryngotracheal stenosis (LS) is most commonly caused by iatrogenic injury, namely, tracheal intubation. The goal of treatment is the maintenance of a patent airway, which is mostly achieved by surgical intervention. Our objective was to study the effect of perioperative variables on tracheal resection anastomosis (TRA)/cricotracheal resection anastomosis (CTRA) surgical outcomes by identifying statistically significant factors associated with postoperative complications and failure of surgery, i.e., restenosis. Methods Data from the medical records of 33 patients who underwent TRA/CTRA was analyzed by univariate and multivariate logistic regression. The data included perioperative variables such as the etiology of stenosis, comorbidities, and postoperative or long-term complications. Results The study included nine females and 24 males, and most (29, 87.88%) were intubated prior to surgery. Nineteen patients (57.57%) developed one or more postoperative complications, i...
Challenging tracheal resection anastomosis: Case series
Auris Nasus Larynx, 2020
This study was conducted to review our experience in Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, in the last 2 years in the management of high-risk patients who underwent cricotracheal resection due to different pathologies. Methods: This case series included nine patients with severe, grade III or IV subglottic / cervical tracheal stenosis. These patients were considered high risk patients due to unusual pathology / etiology of stenosis or associated surgical field morbidity. Four patients had recurrent stenosis after previous unsuccessful cricotracheal resection, three patients had subglottic stenosis due to external neck trauma which compromised the surgical field. One patient had upper tracheal neoplasm, and in 1 patient there was upper tracheal stenosis associated with tracheo-esophageal fistula. Results: Successful decannulation was achieved in all patients (n = 9) without any reported major intraoperative or postoperative compilations. Conclusion: Cases of subglottic / upper tracheal stenosis due to uncommon pathologies like neoplastic lesions, external neck trauma compromising the surgical field and revision cricotracheal resection, can be successfully managed by cricotracheal resection. However, a highly skilled team, well familiar with these surgeries, is mandatory to achieve an optimum outcome.
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.
Anesthetic challenges in tracheal resection and reconstruction surgery
1 Objective: Tracheal stenosis is usually iatrogenic, a result of an accident or due to tracheal tumors. Anesthesia for tracheal resection and reconstruction is a challenging job and requires expertise. The crux of anesthetic management is securing the airway early and maintenance of ventilation and oxygenation during resection and reconstruction. This study is aimed to share the anesthetic management and outcome of 21 cases of tracheal resection and reconstruction surgery for tracheal stenosis. Methodology: This prospective, descriptive study was carried out at PNS Shifa Hospital Karachi and Combined Military Hospital Rawalpindi between October 2014 and July 2018. All 21 patients undergoing tracheal resection and reconstruction surgery for tracheal stenosis at these centers were enrolled. Informed consent was obtained from all patients and institutional ethics committee approval was secured. The site of tracheal stenosis, type of anesthesia used, ventilation and oxygenation before and during resection and anastomosis of trachea and the type of surgery and the outcome was noted. The data were collected in MS Excel sheet and simple statistical analysis done to present the results. Results: Out of 21 patients, 9 (43%) were males and 12 (57%) were females, between 6 to 66 years of age of ASA II-IV. Post intubation stenosis was the leading cause of stenosis followed by tumor, trauma and corrosive ingestion. Fourteen patients had high cervical / subglottic stenosis and were operated by high anterior cervical collar incision, while five had lower tracheal lesions, and 2 had carinal lesion and were operated by right thoracotomy. Seven patients were anesthetized through tracheostomy tube, one by fiberoptic intubation, and the rest with 5-7 mm ETT with or without muscle relaxant. One patient developed cardiac arrest during surgery, but was revived successfully. Four (19%) out of 21 had to be put on ventilator postoperatively while remaining 17 (89%) were extubated on operating table. Two patients on ventilator were weaned of successfully. Outcome was excellent in 19 (90%) cases while in 2 (10%) patients, operation was unsuccessful and they landed up with permanent tracheostomy. Conclusion: The study highlights the importance of prevention of post-intubation tracheal stenosis with strict vigilance and high quality professional nursing care. Thorough preoperative assessment and preparation, intra operative management, a backup plan and close communication between the surgeon and anesthesiologist are necessary for successful outcome. Most of these patients require general anesthesia and profound relaxation.