Tracheobronchial resection for tumor: classification and related biological problems

Abstract

Among 200 tracheobronchoplasties for neoplastic diseases, lung cancer occurred most often, accounting for 126 of cases (63.0%), followed by thyroid cancer in 50 cases (25.0%), and tracheobronchial tumor in 17 (8.5%). Topologically, there are 2 types of laryngotracheal anastomoses in cases of thyroid cancer. At the carinal region, technical problems consisted of operative approaches and approximation between the trachea and bronchi. An APWA (aortopulmonary window approach) was proposed, with a description of the limit of approximation distance. Triple lumen anastomosis of peripheral bronchi was introduced. Anatomically, the thickness of airway wall was discussed in relation to the selection of the best site for the side stoma of the trachea or bronchi. Functionally, the concept of compromised indication of Paulson for lung cancer patients was presented as a conceptual alternative to pneumonectomy or lobectomy. In terms of the elastodynamics of the trachea, mobilization techniques are essential for tracheal tumors, especially in adenoid cystic carcinoma. Concluding from these experiences, stem operative modes could be classified into 8 types each for tracheoplasty and bronchoplasty. In these modes, the standardized mode and carinoplasty were defined, and analyzed in lung cancer cases.