ABSTRACT

Background: Tracheal resection and anastomosis is the gold standard for the treatment of tracheal stenosis. Restenosis is 5 to 22% of cases report, dehiscence stenosis occurs in about 4-7.5% and mortality is 1.8 to 5%. The objective of this study is to evaluate the restenosis after tracheal resection for benign stenosis and the predicting factors for such complications. Material and methods: A retrospective study was made involving patients with benign tracheal or laryngotracheal stenosis who underwent surgical resection and reconstruction between January 2008 and December 2012. Restenosis was studied. Categorical variables were presented as percentage and continuous variables as mean and standard deviation. Predicting factors were determined by logistic regression univariate and multivariate. Statistical significance was set for p less than 0.05. Results: 155 patients (52 female, 103 male) were included. Complications occurred in 52 (33.5%). The most common complication was restenosis (21%). Laryngeal commitment and length greater than 4 cm resection were statistically factors for restenosis. Laryngeal commitment was the most significant factor and was highly associated with restenosis (odds ratio 2.9, CI 95%: 1.2-6.6, p: 0.01). At the end of the study, 146 patients (94.2%) were breathing normally. There was no mortality in this series. Conclusions: Restenosis was the most frequent complication in patients undergoing tracheal resection. Laryngeal commitment and length greater than 4 cm resection were statistically significant factors for the onset of restenosis.

KEYWORDS

Tracheal stenosis, tracheal resection, restenosis, complications.

REFERENCES

1. Allen MS. Surgical anatomy of the trachea. Chest Surg Clin N Am. 2003;13(2):191-199. doi:10.1016/S1052-3359(03)00037-1.

2. Munguía-Canales DA, Ruiz-flores J, Vargas-Mendoza GK, Morales-Gómez J, Méndez-Ramírez I, Murata Ch. Dimensiones traqueales en población mexicana. Cir Cir 2011;79(6):505-510.

3. Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. Thorac Cardiovasc Surg 1995;109(3):486-493.

4. Wain JC. Postintubation tracheal stenosis. Chest Surg Clin N Am 2003;13(2):231-246. doi:10.1016/S1052-3359(03)00034-6.

5. Hashemzadeh S, Hashemzadeh K, Kakaei F, Aligholipour R, Ghabili K. Surgical treatment of postintubation tracheal stenosis : Iranian experience of effect of previous tracheostomy. Int J Gen Med 2012;5:93-98. doi:10.2147/IJGM.S27559.

6. Wright CD, Grillo HC, Wain JC, et al. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg 2004;128(5):731-739. doi:10.1016/j.jtcvs.2004.07.005.

7. Marques P, Leal L, Spratley J, Cardoso E, Santos M. Tracheal resection with primary anastomosis: 10 years experience. Am J Otolaryngol 2009;30(6):415-418. doi:10.1016/j.amjoto.2008.08.008.

8. Bibas BJ, Terra RM, Oliveira Junior AL, et al. Predictors for postoperative complications after tracheal resection. Ann Thorac Surg 2014;98(1):277-282. doi:10.1016/j.athoracsur.2014.03.019.

9. Mutrie CJ, Eldaif SM, Rutledge CW, et al. Cervical tracheal resection: new lessons learned. Ann Thorac Surg 2011;91(4):1101-6; discussion 1106. doi:10.1016/j.athoracsur.2010.11.066.

10. Couraud L, Jougon JB, Velly JF. Surgical treatment of nontumoral stenoses of the upper airway. Ann Thorac Surg 1995;60(2):250-260. doi:10.1016/0003-4975(95)00464-V.

11. Carretta A, Casiraghi M, Melloni G, et al. Montgomery T-tube placement in the treatment of benign tracheal lesions. Eur J Cardiothorac Surg. 2009;36(2):352-356; discussion 356. doi:10.1016/j.ejcts.2009.02.049.

12. George M, Lang F, Pasche P, Monnier P. Surgical management of laryngotracheal stenosis in adults. Eur Arch Otorhinolaryngol 2005;262(8):609-615. doi:10.1007/s00405-004-0887-9.

13. Abbasidezfouli A, Akbarian E, Shadmehr MB, et al. The etiological factors of recurrence after tracheal resection and reconstruction in post-intubation stenosis. Interact Cardiovasc Thorac Surg 2009;9(3):446-449. doi:10.1510/icvts.2009.202978.

14. Stoelben E, Koryllos A, Beckers F, Ludwig C. Benign stenosis of the trachea. Thorac Surg Clin 2014;24(1):59-65. doi: 10.1016/j.thorsurg.2013.09.001.

15. Nakache G, Primov-Fever A, Alon EE, Wolf M. Predicting outcome in tracheal and cricotracheal segmental resection. Eur Arch Otorhinolaryngol 2015;272(6):1471-1475. doi:10.1007/s00405-015-3575-z.

16. Pearson FG, Brito-Filomeno L, Cooper JD. Experience with partial cricoid resection and thyrotracheal anastomosis. Ann Otol Rhinol Laryngol 1986;95(6 Pt 1):582-585.

17. Macchiarini P, Verhoye JP, Chapelier A, Fadel E, Dartevelle P. Partial cricoidectomy with primary thyrotracheal anastomosis for postintubation subglottic stenosis. J Thorac Cardiovasc Surg 2001;121(1):68-76. doi:10.1067/mtc.2001.111420.

18. Couraud L, Jougon J, Velly JF, Klein C. Iatrogenic stenoses of the respiratory tract. Evolution of therapeutic indications. Based on 217 surgical cases. Ann Chir 1994;48(3):277-283.

19. Grillo HC, Zannini P, Michelassi F. Complications of tracheal reconstruction. Incidence, treatment, and prevention. J Thorac Cardiovasc Surg 1986;91(3):322-328.