Sixty tracheal resections - single center experience

Abstract

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.

An experimental model to investigate initial tracheal anastomosis strength

“…Early tracheal dehiscence is a rare but devastating complication of segmental tracheal resection. Although dehiscence is rarely mentioned in many of the large cohort studies discussing tracheal resection,1–6 most surgeons who do a great number of tracheal resection procedures have experience with this complication. In fact, series that document this complication demonstrate an incidence rate between 4% and 14.2% 7–12.…”

“…Grillo described the use of PDS suture as more cumbersome without any advantage shown. The continued use of monofilament (PDS) suture in a few series is presumably based on the idea that monofilament adds early strength and support to the anastomosis 2, 5, 6, 19. Thus, investigating the initial anastomotic strength using Vicryl suture for repair and comparing it to repair with monofilament suture such as PDS is an important area that has not been investigated in human tracheal anastomoses.…”

Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis

“…The options in this case are either oesophageal diversion, or emergency surgery with tracheal resection. Emergency resection of the air duct (if stenosis is present) can also be considered when the fistula is diagnosed in the first 24 to 48 hours from extubation, in patients with a satisfactory health status and lung contamination at minimum levels (6,16,17).…”

Treatment of large tracheal defects after resection: Laryngotracheal release and tracheal replacement

“…Only one patient developed re-stenosis and no cases of anastomotic dehiscence occurred. In comparison, Cordos et al[27] carried out 60 tracheal resections of the same length (up to 4 cm) in the upper third and always performed blunt pretracheal dissection and neck flexion after the operation. Only one patient developed re-stenosis.…”