Reconstruction of Long Noncircumferential Tracheal or Carinal Resections With Bronchial Flaps

Abstract

Removal of tumors that invade the trachea or carina often results in a massive defect that exceeds the limits of end-to-end anastomosis. The purpose of this study is to discuss the clinical value of bronchial flap for the closure of central airway defects after noncircumferential tracheal or carinal resection. From 1990 to 2016, 73 patients underwent noncircumferential tracheal or carinal resection. From size, location, and pulmonary function, there were six different types of bronchial flap reconstruction. We performed bronchial flap upturned reconstruction with right pneumonectomy (n= 45), right upper lobectomy (n= 9), left pneumonectomy (n= 7), left upper lobectomy (n= 3), and bronchial flap downturned reconstruction with right pneumonectomy (n= 5), left pneumonectomy (n= 4). The size of airway defects that were replaced by bronchial flap ranged from 0.5× 2 to 2.5× 7 cm and was at most 50% of the airway circumference. Postoperative major complications occurred in 17.8% (13 of 73) of patients: four bronchopleural fistulas (5.5%), five serious postoperative infections (6.8%), two pulmonary atelectasis (2.7%), and two airway stenosis (2.7%). However, no significant differences were found in postoperative complications between resection lengths shorter than 4 cm and longer than 4 cm (p= 0.295). The overall 30-day mortality rate was 2.7%. The overall survival rate was 63.5% and 23.6% at 2 and 5 years, respectively. The six different types of bronchial flap reconstruction present an efficient therapeutic strategy to close massive central airway defects after noncircumferential tracheal or carinal resection when the patient has poor pulmonary function or when an end-to-end anastomosis is unfeasible and risky.