Long-term postoperative outcomes in patients with cicatricial tracheal stenosis depending on surgical approach

Abstract

To analyze the long-term postoperative outcomes in patients with cicatricial tracheal stenosis and to determine the indications for various surgical strategies. There were 976 patients with benign cicatricial tracheal stenosis for the period 2001-2017. Tracheal stenosis occurred after mechanical ventilation and tracheostomy in 910 (93.2%) patients. Other causes were neck trauma, burns, previous surgery or tuberculosis. Idiopathic stenosis was observed in 41 (4.2%) patients. Multiple-stage reconstructive treatment was possible due to benign nature of disease. There were 2.4 operations per a patient, and 976 patients underwent 2327 procedures. Circular tracheal resection was preferred (n=396). Surgical complications occurred in 107 (4.6%) cases, mortality rate - 0.3%. In long-term period, 42 patients died for various causes. In most cases (n=34, 80.9%), mortality was associated with concomitant diseases or consequences of trauma rather cicatricial tracheal stenosis or its treatment. Eight patients died from cicatricial tracheal stenosis or its treatment (7 patients after staged repair, 1 after circular tracheal resection). Four patients died due to asphyxia following T-tube obturation with a tracheobronchial secret or unjustified decannulation. For various reasons, 41 (6.2%) patients continued their treatment in other hospitals (4 patients died). Mortality rate in this group was 9.8%. Favorable long-term outcome was observed in 90.1% of patients, good and unsatisfactory results - in 7.2% and 1.8% of patients, respectively. Circular tracheal resection ensured better functional outcome. Surgical treatment of cicatricial tracheal stenosis is associated with low incidence of postoperative complications and mortality. However, further improvement in long-term results is associated with advanced rehabilitation programs for concomitant diseases. Treatment of cicatricial tracheal stenosis should be carried out at specialized hospitals.