Surgery Today

, 41:490 | Cite as

Tracheal resection for malignant and benign diseases: Surgical results and perioperative considerations

  • Takeshi Shiraishi
  • Jun Yanagisawa
  • Takao Higuchi
  • Masafumi Hiratsuka
  • Daisuke Hamatake
  • Naoyuki Imakiire
  • Toshiro Ohbuchi
  • Yasuteru Yoshinaga
  • Akinori Iwasaki
Original Article

Abstract

Purpose

Tracheal surgery is an established treatment for various diseases; however, it is still a potentially challenging procedure. We herein discuss the safety of this procedure with regard to the coordination with airway interventional and anesthetic support.

Methods

A tracheal resection was performed on 18 patients. The dyspnea due to pre-existing severe airway stenosis, which was considered to be a risk factor for the safe induction of general anesthesia, was present in 12 (66.7%) cases.

Results

Seven of the 12 patients with pre-existing airway obstruction required interventional airway treatment before surgery. One case with a polyp-like tracheal tumor required venoarterial percutaneous cardiopulmonary support to establish adequate oxygenation before surgery. All 18 cases underwent a segmental resection of the trachea, with the average length of 3.6 rings. Postoperative recovery was uneventful for all but one patient with postintubation tracheal stenosis, who died 17 days after surgery due to a methicillin-resistant Staphylococcus aureus infection. Complications in the other patients included four cases of laryngeal nerve palsy, three of aspiration, and one patient with Horner syndrome, with a total morbidity of 27.7%.

Conclusions

A tracheal resection is currently a safe procedure; however, cooperation with sophisticated airway interventional treatment teams, cardiopulmonary bypass support, or a well-trained anesthesiologist is essential for obtaining a successful outcome, especially for the cases with pre-existing severe airway obstruction.

Key words

Tracheal resection Reconstruction Tracheal tumor Tracheal stenosis 

References

  1. 1.
    Küster E. Über narbige Stenosen der Trachea. Zentralbl Chir 1886;13:759–760.Google Scholar
  2. 2.
    Grillo HC. Circumferential resection and reconstruction of the mediastinal and cervical trachea. Ann Surg 1965;162(3):374–388.PubMedCrossRefGoogle Scholar
  3. 3.
    Perelman M, Korolyova N. Surgery of tumours in the thoracic portion of the trachea. Thorax 1968;23(3):307–310.PubMedCrossRefGoogle Scholar
  4. 4.
    Grillo HC. The management of tracheal stenosis following assisted respiration. J Thorac Cardiovasc Surg 1969;57(1):52–71.PubMedGoogle Scholar
  5. 5.
    Grillo HC. Tracheal tumors: surgical management. Ann Thorac Surg 1978;26(2):112–125.PubMedCrossRefGoogle Scholar
  6. 6.
    Conley JJ. Reconstruction of the subglottic air passage. Ann Otol Rhinol Laryngol 1953;62:477–495.PubMedGoogle Scholar
  7. 7.
    MacManus JE, McCormic R. Resection and anastomosis of the intrathoracic trachea for primary neoplasm. Ann Surg 1954;139:350–354.PubMedCrossRefGoogle Scholar
  8. 8.
    Pearson FG, Andrews MJ. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg 1971;12(4):359–374.PubMedCrossRefGoogle Scholar
  9. 9.
    Grillo HC, Dignan EF, Miura T. Extensive resection and reconstruction of mediastinal trachea without prosthesis or graft: an anatomical study in man. J Thorac Cardiovasc Surg 1964;48:741–749.PubMedGoogle Scholar
  10. 10.
    Keshavjee S, Pearson FG. Tracheal resection. In: Pearson FG, Cooper JD, Deslauriers J, Ginsberg RJ, Hiebert C, Patterson G, et al., editors. Thoracic surgery. 2nd ed. New York: Churchill Livingstone; 2002. p. 405–415.Google Scholar
  11. 11.
    Schneider P, Schirren J, Muley T, Vogt-Moykopf I. Primary tracheal tumors: experience with 14 resected patients. Eur J Cardiothorac Surg 2001;20(1):12–18.PubMedCrossRefGoogle Scholar
  12. 12.
    Pearson FG, Cardoso P, Keshavjee S. Upper airway tumor primary tumors. In: Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC Jr, editors. Thoracic surgery. New York: Churchill Livingstone; 1995. p. 285–299.Google Scholar
  13. 13.
    Shiraishi T, Kawahara K, Shirakusa T, Tashiro T, Imakiire T, Okabayashi K, et al. Primary tracheal fibrosarcoma in a child: a case of tracheal resection under ECMO support. Thorac Cardiovasc Surg 1997;45(5):252–254.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Takeshi Shiraishi
    • 1
  • Jun Yanagisawa
    • 1
  • Takao Higuchi
    • 1
  • Masafumi Hiratsuka
    • 1
  • Daisuke Hamatake
    • 1
  • Naoyuki Imakiire
    • 1
  • Toshiro Ohbuchi
    • 1
  • Yasuteru Yoshinaga
    • 1
  • Akinori Iwasaki
    • 1
  1. 1.Department of Thoracic, Endocrine and Pediatric SurgeryFukuoka University School of MedicineFukuokaJapan

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