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Wei S, Yang B, Bi T, Zhang W, Sun H, Cui Y, Li G, Zhang A. Tracheal replacement with aortic grafts: Bench to clinical practice. Regen Ther 2023; 24:434-442. [PMID: 37744679 PMCID: PMC10514392 DOI: 10.1016/j.reth.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Tracheal reconstruction following extensive resection for malignant or benign lesions remains a major challenge in thoracic surgery. Numerous studies have attempted to identify the optimal tracheal replacement with different biological or prosthetic materials, such as various homologous and autologous tissues, with no encouraging outcomes. Recently, a few clinical studies reported attaining favorable outcomes using in vitro or stem cell-based airway engineering and also with tracheal allograft implantation following heterotopic revascularization. However, none of the relevant studies offered a standardized technology for airway replacement. In 1997, a novel approach to airway reconstruction was proposed, which involved using aortic grafts as the biological matrix. Studies on animal models reported achieving in-vivo cartilage and epithelial regeneration using this approach. These encouraging results inspired the subsequent application of cryopreserved aortic allografts in humans for the first time. Cryopreserved aortic allografts offered further advantages, such as easy availability in tissue banks and no requirement for immunosuppressive treatments. Currently, stented aortic matrix-based airway replacement has emerged as a standard approach, and its effectiveness was also verified in the recently reported TRITON-01 study. In this context, the present review aims to summarize the current status of the application of aortic grafts in tracheal replacement, including the latest advancements in experimental and clinical practice.
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Affiliation(s)
- Shixiong Wei
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
- The Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Bo Yang
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Taiyu Bi
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Wenyu Zhang
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - He Sun
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Yongsheng Cui
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Guanghu Li
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Anling Zhang
- The Department of Maxillofacial Surgery, Jilin FAW General Hospital, Changchun, Jilin Province, 130000, China
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Estephan J, Mercier O, Thomas de Montpreville V, Hanna A, Leymarie N, Le Pechoux C, Fadel E. Retrospective study of outcomes after extended resection for tracheobronchial adenoid cystic carcinoma. J Thorac Cardiovasc Surg 2023; 165:1954-1964.e5. [PMID: 36528436 DOI: 10.1016/j.jtcvs.2022.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Tracheobronchial adenoid cystic carcinoma is a rare, slow-growing malignancy with a considerable propensity for local extension that may require complex airway resection to achieve tumor-free margins. The objective of this study was to assess whether our experience supports complex airway resection for tracheobronchial adenoid cystic carcinoma. METHODS Consecutive patients who underwent curative resection for tracheobronchial adenoid cystic carcinoma at our institution between 1970 and 2019 were included retrospectively and classified as having had complex or standard resection. Complex surgery included total tracheal replacement, associated esophageal resection, pneumonectomy, total laryngectomy with tracheal resection, and carinal resection. Standard surgery included tracheal resection, bronchoplastic resection, lobectomy, and bilobectomy. We obtained data from medical records, referring physicians, patients, relatives, and public death records. RESULTS Of 59 included patients, 38 had complex and 21 had standard surgery. All 4 (6.8%) patients who died postoperatively had undergone complex surgery. Postoperative morbidity was 32.2% overall and was significantly higher after complex surgery (P = .043). Overall 5- and 10-year survival rates were 81.5% and 60.2%, with no significant differences between groups (P = .31). By univariate analysis, T4 tumor and microscopically detectable tumor in the operative specimen margins and gross tumor in the operative specimen margins were associated with poorer survival (P < .05). In the subgroup with microscopically detectable tumor resection, survival was significantly better with adjuvant radiotherapy (P < .05). CONCLUSIONS Complex resection for extended tracheobronchial adenoid cystic carcinoma may achieve local control and satisfying long-term survival. However, this demanding procedure is associated with high postoperative morbidity and mortality rates. Because adjuvant radiotherapy improved outcomes after resection resulting in microscopically detectable tumor in the operative specimen margins, expected outcomes after resection with no detectable tumor in the margins must be compared to those after resection resulting in microscopically detectable tumor in the margins plus radiotherapy, according to the operative risk.
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Affiliation(s)
- Jérôme Estephan
- Medical University, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Olaf Mercier
- Medical University, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | | | - Amir Hanna
- Interventional Pulmunology Division, Department of Pulmonary Medicine, Université Paris-Saclay, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery, Gustave Roussy, Villejuif, France
| | | | - Elie Fadel
- Medical University, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France.
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Mahoney C, Conklin D, Waterman J, Sankar J, Bhattarai N. Electrospun nanofibers of poly(ε-caprolactone)/depolymerized chitosan for respiratory tissue engineering applications. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2016; 27:611-25. [DOI: 10.1080/09205063.2016.1144454] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Martinod E, Seguin A, Radu DM, Boddaert G, Chouahnia K, Fialaire-Legendre A, Dutau H, Vénissac N, Marquette CH, Baillard C, Valeyre D, Carpentier A. Airway transplantation: a challenge for regenerative medicine. Eur J Med Res 2013; 18:25. [PMID: 24059453 PMCID: PMC3750833 DOI: 10.1186/2047-783x-18-25] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022] Open
Abstract
After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization. In 1997, we proposed a novel approach: the use of aortic grafts as a biological matrix for extensive airway reconstruction. In vivo regeneration of epithelium and cartilage were demonstrated in animal models. This led to the first human applications using cryopreserved aortic allografts that present key advantages because they are available in tissue banks and do not require immunosuppressive therapy. Favorable results obtained in pioneering cases have to be confirmed in larger series of patients with extensive tracheobronchial diseases.
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Affiliation(s)
- Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Agathe Seguin
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Dana M Radu
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Guillaume Boddaert
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Kader Chouahnia
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Oncology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Anne Fialaire-Legendre
- Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, EFS Ile de France, Tissue Bank, Paris, France
| | - Hervé Dutau
- Assistance Publique-Hôpitaux de Marseille, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Nicolas Vénissac
- CHU Nice, Pasteur Hospital, Department of Thoracic Surgery, Nice, France
| | | | - Christophe Baillard
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Anesthesiology and Intensive Care, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Dominique Valeyre
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Pneumonology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Alain Carpentier
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
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Seguin A, Radu DM, Martinod E. Reply to the editor. J Thorac Cardiovasc Surg 2013; 145:1418-9. [PMID: 23597629 DOI: 10.1016/j.jtcvs.2013.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/11/2013] [Indexed: 11/16/2022]
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Martinod E. [Tracheal replacement with cryopreserved aortic allograft: a "hot topic" in thoracic surgery]. Rev Mal Respir 2012; 29:939-40. [PMID: 22980557 DOI: 10.1016/j.rmr.2011.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/02/2010] [Indexed: 10/17/2022]
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7
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Martinod E. Airway transplantation using aortic allografts: a 'hot topic'. Eur J Cardiothorac Surg 2012; 41:1409-10; author reply 1410. [DOI: 10.1093/ejcts/ezr256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Wurtz A, Hysi I. [Tracheal replacement with aortic allografts in humans. Experimental prospects]. Rev Mal Respir 2011; 29:941-4. [PMID: 22980558 DOI: 10.1016/j.rmr.2011.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 08/24/2010] [Indexed: 12/17/2022]
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Editorial comment. Eur J Cardiothorac Surg 2011; 39:754-5. [DOI: 10.1016/j.ejcts.2010.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 09/04/2010] [Accepted: 09/05/2010] [Indexed: 11/18/2022] Open
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Walles T. Tracheobronchial bio-engineering: biotechnology fulfilling unmet medical needs. Adv Drug Deliv Rev 2011; 63:367-74. [PMID: 21295094 DOI: 10.1016/j.addr.2011.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/25/2011] [Accepted: 01/27/2011] [Indexed: 12/11/2022]
Abstract
The development of substitutes for the human trachea or its bronchial tree represents a niche application in the rapidly advancing scientific field of Regenerative Medicine. Despite a comparatively small research foundation in the field of tracheo-bronchial bioengineering, four different approaches have already been translated into clinical settings and applied in patients. This can be attributed to the lack of established treatment options for a small group of patients with extensive major airway disease. In this review, the clinical background and tissue-specific basics of tracheo-bronchial bioengineering will be evaluated. Focusing on the clinical applications of bioengineered tracheal tissues, a "top-down" or "bedside-to-bench" analysis is performed in order to guide future basic and clinical research activities for airway bioengineering.
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Affiliation(s)
- Thorsten Walles
- Robert-Bosch-Hospital GmbH, Schillerhoehe Hospital, Department of General Thoracic Surgery, Gerlingen, Germany.
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Martinod E, Radu DM, Chouahnia K, Seguin A, Fialaire-Legendre A, Brillet PY, Destable MD, Sebbane G, Beloucif S, Valeyre D, Baillard C, Carpentier A. Human Transplantation of a Biologic Airway Substitute in Conservative Lung Cancer Surgery. Ann Thorac Surg 2011; 91:837-42. [PMID: 21353009 DOI: 10.1016/j.athoracsur.2010.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 11/07/2010] [Accepted: 11/08/2010] [Indexed: 12/20/2022]
Affiliation(s)
- Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, CHU Avicenne, Pôle Hémato-Onco-Thorax, Université Paris 13, Faculté de Médecine SMBH, Bobigny, France.
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Fadel E, Fabre D. [Tracheal replacement: the end of disillusions?]. Rev Mal Respir 2010; 27:550-1. [PMID: 20610069 DOI: 10.1016/j.rmr.2010.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 05/01/2010] [Indexed: 11/29/2022]
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