Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses

Piazza, Cesare; Bon, Francesca Del; Paderno, Alberto; Grazioli, Paola; Mangili, Stefano; Lombardi, Davide; Nicolai, Piero; Peretti, Giorgio

doi:10.1177/0003489414538764

Cited by 51 publications

(70 citation statements)

References 32 publications

(74 reference statements)

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“…In our series, RLN palsy was seen in four patients (9%) after LTR and in two patients (4%) after STR-ETE. Our results are comparable with findings in other reported series, where RLN palsy is found in 2% to 13% of patients after (laryngo)tracheal surgery (20,23,24). On the other hand, voice alterations without RLN palsy were reported twice as much after LTR when compared to STR-ETE (34% versus 16%, P=0.034).…”

Section: Discussionsupporting

confidence: 90%

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Timman¹,

Schoemaker²,

Li³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: In this study we focus on functional outcomes after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis, with a specific interest in the impact of laryngeal involvement on postoperative outcome.Methods: All patients who underwent (laryngo)tracheal surgery for benign pathology between 1996 and 2017 in our centre were included in this retrospective study. Surgical outcomes were procedural success rate, and airway-and voice-related complications. Functional results were assessed using (standardized) questionnaires for quality of life, sensation of dyspnea, swallowing function, and voice perception.Results: Of 119 consecutive patients, 47 underwent laryngotracheal resection and reconstruction and 72 underwent segmental tracheal surgery (78% with an end-to-end tracheal anastomosis and 22% with a cricotracheal anastomosis). Overall success rate was 92% and was similar for all groups, with an overall significant improvement in quality of life when compared to the preoperative situation. However, after laryngotracheal surgery, airway-related complications were more common when compared to segmental resections with an end-to-end tracheal anastomosis (30% versus 7%, P=0.003). Additionally, early voice alterations without recurrent nerve palsy were reported twice as often (34% versus 16%, P=0.034) and voice quality experienced during follow-up was significantly worse when compared to segmental resections.Overall response rate to the questionnaires on functional outcome was 63%.Conclusions: (Laryngo)tracheal surgery is safe and beneficial, with significant functional improvement during mid-and long-term follow-up. However, laryngeal involvement is a predictor for increased surgical airway-related complications. Additionally, voice alterations without recurrent nerve palsy are far more common after laryngotracheal resection and are a serious handicap. This aspect is underexposed in current literature and deserves further attention during preoperative counseling and patient follow-up. However, the results on functional outcome of this current study should be interpreted with caution due to the somewhat low response rate of the questionnaires.

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Section: Discussionsupporting

confidence: 90%

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Timman¹,

Schoemaker²,

Li³

et al. 2018

Ann. Cardiothorac. Surg.

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“…All patients underwent surgical procedures including circumferential airway resection with subsequent end‐to‐end anastomosis, classified according to Piazza and coworkers . In particular, 53 patients (32%) underwent type A resection (i.e., TRA with removal of tracheal rings only, with subsequent cricotracheal or tracheo‐tracheal anastomosis).…”

Section: Methodsmentioning

confidence: 99%

“…The craniocaudal extension of stenosis has been found to be another important predictor in airway surgery. Longer stenosis requiring more extended excision of the airway segment may potentially cause more tension at the anastomotic line . This may cause anastomosis dehiscence or necrosis with secondary granulation, fibrosis, and restenosis .…”

Section: Introductionmentioning

confidence: 99%

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Fiz¹,

Monnier

Koelmel³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis Introduction and widespread use of cricotracheal resection and anastomosis (CTRA) as routine treatment for high‐grade benign laryngotracheal stenosis (LTS) led to the need for a new classification system that could accurately predict surgical outcomes by integrating crucial stenosis and patient‐related information. In 2015, the European Laryngological Society (ELS) proposed a new classification for benign LTS. We retrospectively tested it in adults treated at three referral centers to assess its reliability in predicting surgical outcomes. Study Design Retrospective cohort study. Methods We included 166 adults treated by open tracheal resection and anastomosis (TRA) and CTRA procedures, restaged according to the ELS classification evaluating grade of stenosis (I–IV, Myer‐Cotton), number of subsites involved, and presence of systemic comorbidities. We correlated these parameters with decannulation, number of retreatments, and complications. Results Final decannulation was predicted by a proposed ELS score ≥ IIIb, history of previous treatment, and length of resection (P < .05). Decannulation was achieved in 99% of patients without and in 88% of patients with surgical complications (P < .01). The incidence of surgical complications was related to the proposed ELS score (P < .01); an ELS score < IIIb showed a lower complication rate compared to patients with a ≥ IIIb score (32.8% vs. 57.7%, P < .01). Additional treatment was required in 73 (44%) patients (mean = 2.7 ± 2.2, range = 1–11). ELS score ≥ IIIb, length of resection, and occurrence of surgical complications predicted the number of such treatments (P < .05, P < .05, and P < .001, respectively). Conclusions ELS classification of benign LTS is able to accurately predict success in adult TRA/CTRA procedures and may be helpful in choice of therapy and patient counseling. Level of Evidence 2b Laryngoscope, 130:1640–1645, 2020

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“…For minor grades of stenosis (Grades I, II and minor Grade III), endotracheal tubes may be used, as recommended by Myer and Cotton [25]. This airway grading system has been shown to be relevant for predicting the success rate of LTRs for various degrees of stenosis, the minor grades having a much better decannulation rate than the most severe grades.…”

Section: Direct Transoral Laryngotracheoscopy With a Bare Zero-degreementioning

confidence: 99%

Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society

Monnier

Dikkers

Eckel

et al. 2015

Eur Arch Otorhinolaryngol

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Adult and pediatric laryngotracheal stenoses (LTS) comprise a wide array of various conditions that require precise preoperative assessment and classification to improve comparison of different therapeutic modalities in a matched series of patients. This consensus paper of the European Laryngological Society proposes a five-step endoscopic airway assessment and a standardized reporting system to better differentiate fresh, incipient from mature, cicatricial LTSs, simple one-level from complex multilevel LTSs and finally ''healthy'' from ''severely morbid'' patients. The proposed scoring system, which integrates all of these parameters, may be used to help define different groups of LTS patients, choose the best treatment modality for each individual patient and assess distinct post-treatment outcomes accordingly.

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Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses

Abstract: Even though the overall success rate of TRA/CTRA is high, it should always be regarded as a major surgical procedure with a non-negligible incidence of complications.

Cited by 51 publications

References 32 publications

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society

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