Revision cricotracheal resection: our experience

Management of Tracheal Surgery Complications and Redo Tracheal Surgery

Tracheal surgery is associated with low mortality but substantial morbidity. Major complications after tracheal and laryngotracheal resection and reconstruction may affect a significant percentage of patients. Anastomotic complications include granulations, dehiscence, and recurrent stenoses. Breakdown of the airway anastomosis may lead to catastrophic complications such as tracheoinnominate and tracheoesophageal fistulas. Nonanastomotic complications include recurrent laryngeal nerve injury, glottic dysfunction, and respiratory infections. This article discusses complications occurring after tracheal surgery and offers strategies for optimizing patient outcomes based on current evidence. The final sections provide a summary of best practices for redo tracheal surgery and current challenges.

Tracheal resection anastomosis for rare tracheal inflammatory lesions mimicking malignancy: report of 2 cases

BACKGROUND

Tumor-like lesions of the trachea are rare and challenging in diagnosis and management. Inflammatory myofibroblastoma, also known as Inflammatory pseudo tumors (IPTs), as well as Rosai Dorfman Disease (RDD) are inflammatory lesions that may involve the central airways with variable non-specific clinical features mimicking tumors.

CASE PRESENTATION

In this study 2 cases with tumor-like lesions are presented. One case with an inflammatory pseudotumor and the other one with Rosai-Dorfman disease affecting the upper trachea. Both cases were successfully managed with tracheal resection anastomosis.

CONCLUSION

Tracheal Inflammatory myofibroblastoma, and Rosai-Dorfman diseases are rare tumor like lesions that present with upper airway obstruction. Despite being benign, these lesions may have features suggestive of malignancy, requiring prompt management. Complete surgical excision by segmental resection and primary anastomosis (if feasible) is the treatment of choice with an optimum outcome.

Hormone pathway comparison in non-idiopathic and idiopathic progressive subglottic stenosis

PURPOSE

Our previous study on the idiopathic progressive subglottic stenosis (IPSS) highlighted a possible hormonal mechanism, with over-expression of estrogen receptors alpha (ER-α) and progesterone receptors (PR). We tested whether such over-expression take place in non-idiopathic subglottic stenosis (NISS) as well.

METHODS

37 specimens of iatrogenic NISS were analyzed (20 females; mean age, 59 ± 12 years; range 41-85). Immunoreactivity of ER-α and PR was calculated as the product of intensity (1 = weak, 2 = moderate, 3 = strong) and positive cells percentage (1 to 4, for < 10%, 10-50%, 50-80%, and > 80%). This score was calculated on the stenotic tissue (ST), and stenosis margins (SM).

RESULTS

The expression of PR was significantly higher in ST of IPSS compared with female and male NISS patients (8.7 ± 3.1 vs. 4.9 ± 3.2, p < 0.001 for IPSS vs. female and 8.7 ± 3.1 vs. 2.1 ± 2.7, p < 0.01 for IPSS vs. male NISS patients). Contrarily, ER-α showed gender differences, as both IPSS and female NISS patients had similar, yet higher ER-α expression compared with male NISS patients (7.0 ± 4.2 vs. 6.5 ± 2.5, p = NS for IPSS vs. female and 7.0 ± 4.2 vs. 3.4 ± 2.0, p < 0.02 for IPSS vs. male NISS patients). There was no difference in fibroblast receptor expression between ST and SM. However, ER-α and PR expression was significantly lower in marginal mucous glands when compared with ST.

CONCLUSIONS

The IPSS pathogenesis appears to be driven by hormonal mechanisms, in particular, by over-expression of PR. Marginal cells display a reduced hormone receptor density. This finding could be interpreted as a compensatory mechanism. These findings could open up for targeted IPSS treatment.

The critical period for development of secondary restenosis following post-intubation tracheal stenosis surgery

BACKGROUND

Determining a predictable duration to restenosis very essential for reducing mortality and morbidity for tracheal stenosis surgery.

OBJECTIVES

The aim of this study was to determine the critical periods for secondary restenosis risk for operated patients with post-intubation tracheal stenosis (PITS) during the initial healing period.

METHODS

A total of 61 patients with a diagnosis of surgically treated PITS were included in the study. Treatment groups were carbon dioxide (CO₂) laser and tracheal resection with primary anastomosis (TRPA). Duration to restenosis was compared with Kaplan-Meier curves between study groups.

RESULTS

Restenosis developed in 11 (18.0%) patients and was diagnosed after a mean of 39.3 ± 38.5 (range, 22 to 155) days. Gender or Cotton-Myer grade of the PITS was not found to be risk factors for the development of stenosis. Restenosis rate was 33.3% in CO₂ laser group and 10% in the TRPA group (p = .036). Duration to restenosis was detected at a median of 28 days in patients treated with CO₂ laser, and a median of 30 days in patients treated with TRPA (p = .024).

CONCLUSIONS

The most critical period for the development of restenosis after PITS treatment is the third and fourth weeks, especially in patients treated with CO₂ laser.