Anastomotic complications after tracheal resection: Prognostic factors and management

Abstract

Tracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation.

Extubation of the surgically resected airway — a role for remifentanil and propofol infusions

“…9 Despite these precautions, anastomotic complications still occur in 9% of patients undergoing this type of surgery; risk factors for complication include a resection of > 4 cm of trachea and the need for tracheostomy before the operation. 3 As our patient had these two risk factors he was considered to be at relatively high risk of developing anastomotic complications. Though poor vascularity of the tissues and superadded infection are described as the common reasons for dehiscence of a tracheal anastomosis, the presence of the inflated cuff of the tracheal tube, coughing or bucking and any trauma during extubation or reintubation can potentially cause tracheal rupture.…”

“…3 Therapeutic options include balloon dilatation, stenting and laser excision of the lesion, as well as tracheal resection surgery. [4][5][6] If dilatation or stenting are used, multiple operations may be necessary.…”

Tracheal surgery

“…Surgery was performed for postintubation stenosis in most cases (589). Other indications for resection were tumours (208 patients), idiopathic laryngo-tracheal stenosis (83) and tracheo-esophageal fistula (21) [31]. The overall success rate was 95%.…”

Confronting the fundamental challenges of airway surgery: a paradigm shift is practically upon us

“…This surgical tipping "point" lead to the allowance of a permissible positive surgical margin with the understanding that postoperative radiation would be required. Technically, the challenges of airway resection have been the extent of longitudinal spread, with tumors less than 4 cm in length generally considered resectable (3,4). Morbidity and mortality factors usually relate to tracheal devascularization or excessive anastomotic tension, which traditionally explained the decision to accept residual microscopic disease to avoid excessive tracheal resection (4).…”

“…Morbidity and mortality factors usually relate to tracheal devascularization or excessive anastomotic tension, which traditionally explained the decision to accept residual microscopic disease to avoid excessive tracheal resection (4). There are rare instances when tracheal resection up to 6 cm in length may be considered, but then other maneuvers are required including bilateral hilar release, cervical tracheal mobilization, suprahyoid laryngeal release, and division of the inferior pulmonary ligaments (3,4).…”