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Thorac Cardiovasc Surg 2022; 70(06): 505-512
DOI: 10.1055/s-0041-1728772
Original Thoracic

Tracheal Resection after Previous Treatment Provides Comparable Outcome to Primary Surgery

Alexis Slama  ‡   *
1   Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
,
Mohamed Zaatar‡   *
1   Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
,
Muhittin Demir
2   Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
,
Oezlem Okumus
1   Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
,
Stefan Mattheis
2   Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
,
Sandra Kampe
3   Department of Anesthesiology, Ruhrlandklinik, University Medicine Essen, Essen, Germany
4   Department of Anaesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany
,
Kaid Darwiche
5   Division of Interventional Pneumology, Ruhrlandklinik, University Medicine Essen, Essen, Germany
,
Stephan Lang
2   Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
,
Clemens Aigner 
1   Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
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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.

Keywords

trachea - airway - larynx

* Both Authors contributed equally to this work.




Publication History

Received: 11 November 2020

Accepted: 15 March 2021

Article published online:
01 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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