RSS-Feed abonnieren
DOI: 10.1055/s-0041-1728772
Tracheal Resection after Previous Treatment Provides Comparable Outcome to Primary Surgery
![](https://www.thieme-connect.de/media/thoracic/202206/lookinside/thumbnails/10-1055-s-0041-1728772_206105ot-1.jpg)
Abstract
Background Tracheal and laryngotracheal surgery provides both excellent functional results and long-term outcomes in the treatment of tracheal stenosis. Consequently, challenging re-resections are rarely necessary. The purpose of this study was to compare the outcome of (laryngo-)tracheal re-resection and surgery after bronchoscopic interventions with that of primary surgery.
Methods Patients undergoing resection for benign tracheal stenosis at our center between 1/2016 and 4/2020 were included. Perioperative characteristics and functional outcomes of patients were used for statistical analysis.
Results Sixty-six patients who underwent (laryngo-)tracheal resection were included (previous resection [A = 6], previous stent [B = 6], previous bronchoscopic intervention w/o stenting [C = 19], untreated [D = 35]). Baseline parameters were largely comparable between groups with exception from group B that had significantly worse lung function. Group A necessitated more complex reconstructions (end-to-end: n = 1: 17%| cricotracheal n = 2: 33%| cricotracheal with mucosectomy n = 2: 33%| laryngoplasty: n = 1: 17%) than patients in group D (end-to-end n = 21: 60%| cricotracheal n = 14: 40%). Postoperative outcomes were comparable throughout groups (intensive care unit: 1[1–18] days; hospital stay: 8[5–71] days). Anastomotic complications were higher after previous stenting (A: 0%; B: 33.3%; C: 10.5%; D: 2.9%; B/D p = 0.008| surgical revisions: A: 16.7%; B: 33.3%; C: 0%; D: 5.7%; B/D, p = 0.035). Overall, postoperative lung function was significantly better (forced expiratory volume in 1 second: 63% ± 24 vs. 75% ± 20; p = 0.001 | PeakEF 3.3 ± 1.9 vs. 5.0 ± 2.2L; p = 0.001). No 90-day mortality was observed in any group. Median follow-up was 12(1–47) months.
Conclusion In carefully selected patients treated in a specialized center, tracheal or laryngotracheal resection after previous tracheal interventions provides comparable outcome to primary surgery.
* Both Authors contributed equally to this work.
Publikationsverlauf
Eingereicht: 11. November 2020
Angenommen: 15. März 2021
Artikel online veröffentlicht:
01. Juni 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995; 109 (03) 486-492 , discussion 492–493
- 2 Wright CD, Grillo HC, Wain JC. et al. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg 2004; 128 (05) 731-739
- 3 Wright CD, Li S, Geller AD. et al. Postintubation tracheal stenosis: management and results 1993 to 2017. Ann Thorac Surg 2019; 108 (05) 1471-1477
- 4 Mutrie CJ, Eldaif SM, Rutledge CW. et al. Cervical tracheal resection: new lessons learned. Ann Thorac Surg 2011; 91 (04) 1101-1106 , discussion 1106
- 5 Schweiger T, de Faria Soares Rodrigues I, Roesner I. et al. Laryngeal mask as the primary airway device during laryngotracheal surgery: data from 108 patients. Ann Thorac Surg 2020; 110 (01) 251-257
- 6 Wang H, Wright CD, Wain JC, Ott HC, Mathisen DJ. Idiopathic subglottic stenosis: factors affecting outcome after single-stage repair. Ann Thorac Surg 2015; 100 (05) 1804-1811
- 7 Donahue DM, Grillo HC, Wain JC, Wright CD, Mathisen DJ. Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis. J Thorac Cardiovasc Surg 1997; 114 (06) 934-938 , discussion 938–939
- 8 Bibas BJ, Terra RM, Oliveira Junior AL. et al. Predictors for postoperative complications after tracheal resection. Ann Thorac Surg 2014; 98 (01) 277-282
- 9 Gelbard A, Anderson C, Berry LD. et al. Comparative treatment outcomes for patients with idiopathic subglottic stenosis. JAMA Otolaryngol Head Neck Surg 2020; 146 (01) 20-29
- 10 Carpenter PS, Pierce JL, Smith ME. Outcomes after cricotracheal resection for idiopathic subglottic stenosis. Laryngoscope 2018; 128 (10) 2268-2272
- 11 Menapace DC, Modest MC, Ekbom DC, Moore EJ, Edell ES, Kasperbauer JL. Idiopathic subglottic stenosis: long-term outcomes of open surgical techniques. Otolaryngol Head Neck Surg 2017; 156 (05) 906-911
- 12 Madariaga ML, Gaissert HA. Reresection for recurrent stenosis after primary tracheal repair. J Thorac Dis 2016; 8 (Suppl. 02) S153-S159
- 13 Fiz I, Koelmel JC, Piazza C. et al. Predictors of recurrence after surgical treatment of idiopathic progressive subglottic stenosis. Acta Otorhinolaryngol Ital 2018; 38 (05) 417-423
- 14 Smith ME, Elstad M. Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one?. Laryngoscope 2009; 119 (02) 272-283
- 15 Gelbard A, Donovan DT, Ongkasuwan J. et al. Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. Laryngoscope 2016; 126 (06) 1390-1396
- 16 Nouraei SA, Singh A, Patel A, Ferguson C, Howard DJ, Sandhu GS. Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis. Laryngoscope 2006; 116 (08) 1417-1421
- 17 Gelbard A, Francis DO, Sandulache VC, Simmons JC, Donovan DT, Ongkasuwan J. Causes and consequences of adult laryngotracheal stenosis. Laryngoscope 2015; 125 (05) 1137-1143
- 18 Maldonado F, Loiselle A, Depew ZS. et al. Idiopathic subglottic stenosis: an evolving therapeutic algorithm. Laryngoscope 2014; 124 (02) 498-503
- 19 Lavrysen E, Hens G, Delaere P, Meulemans J. Endoscopic treatment of idiopathic subglottic stenosis: a systematic review. Front Surg 2020; 6: 75
- 20 Hseu AF, Benninger MS, Haffey TM, Lorenz R. Subglottic stenosis: a ten-year review of treatment outcomes. Laryngoscope 2014; 124 (03) 736-741
- 21 Jović RM, Dragičević D, Komazec Z, Mitrović S, Janjević D, Gašić J. Laryngotracheal stenosis and restenosis. What has the influence on the final outcome?. Eur Arch Otorhinolaryngol 2012; 269 (07) 1805-1811
- 22 Ashiku SK, Kuzucu A, Grillo HC. et al. Idiopathic laryngotracheal stenosis: effective definitive treatment with laryngotracheal resection. J Thorac Cardiovasc Surg 2004; 127 (01) 99-107
- 23 Montgomery WW. Suprahyoid release for tracheal anastomosis. Arch Otolaryngol 1974; 99 (04) 255-260
- 24 Donahue DM. Reoperative tracheal surgery. Chest Surg Clin N Am 2003; 13 (02) 375-383
- 25 Gaissert HA, Grillo HC, Wright CD, Donahue DM, Wain JC, Mathisen DJ. Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardiovasc Surg 2003; 126 (03) 744-747
- 26 Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: prevention and treatment. J Thorac Dis 2016; 8 (Suppl. 02) S160-S167
- 27 Piazza C, Del Bon F, Paderno A. et al. Complications after tracheal and cricotracheal resection and anastomosis for inflammatory and neoplastic stenoses. Ann Otol Rhinol Laryngol 2014; 123 (11) 798-804
- 28 Hoetzenecker K, Schweiger T, Roesner I. et al. A modified technique of laryngotracheal reconstruction without the need for prolonged postoperative stenting. J Thorac Cardiovasc Surg 2016; 152 (04) 1008-1017
- 29 Stanifer BP, Andrei AC, Liu M. et al. Short-term outcomes of tracheal resection in the society of thoracic surgeons database. Ann Thorac Surg 2018; 106 (06) 1612-1618
- 30 Erelel M, Kaya S, Toker A. Anastomotic stenotic complications after tracheal resections. J Bronchology Interv Pulmonol 2010; 17: 142-145
- 31 Saghebi SR, Abbasidezfouli A, Sheikhy K, Farzanegan R. A successful third resection-anastomosis in a tracheal restenosis. Interactive cardiovascular and thoracic surgery 2012; 15: 174-175