Extensive tracheal resections and reconstruction

Abstract

Tracheal sleeve resection and primary anastomosis are generally accepted as the methods of choice for tracheal repair. Malignant neoplasms, restenosis after surgery, and failure of conservative management (dilatation or stents) require extensive resection with additional surgical maneuvers to enable an anatomic end-to-end anastomosis. Since 1975, 33 patients underwent a extensive resection of one half or more of the trachea. There were 21 male and 12 female patients: mean age was 46.4 years (range 16 to 64 years). Rigid bronchoscopy, tracheography and computed tomography is used to specify the length of the stenosis, the distance from the vocal cords and, in cases of tumor, the extent and invasion of mediastinal structures. Besides the tracheal resection, suprahyoid laryngeal release (n = 13), pericardial incision and mobilization of the right lung hilus (n = 8), additionally mobilization of the left lung with division of Bottali ligament (n = 4), laryngeal release and hilus mobilization (n = 6), and division of the left main bronchus and reimplantation in the bronchus intermedius (n = 2) were used to reduce tension on the anastomosis. One postoperative death resulted from rupture of the innominate artery. Long-term results were excellent in 22 patients, good in 6, satisfactory in 3, and poor in 2. In our experience, extensive tracheal resection and reconstruction using different release procedures are safe with good long-term results.