Elsevier

The Annals of Thoracic Surgery

Volume 64, Issue 5, November 1997, Pages 1429-1432
The Annals of Thoracic Surgery

Surgical Management of Tracheal Tumors

https://doi.org/10.1016/S0003-4975(97)00818-7Get rights and content

Background

Resection of tracheal tumors is particularly challenging when the neoplasm involves the carina or is located in close proximity. We reviewed our experience with 22 tracheal resections for tumor.

Methods

In this retrospective review, adenoid cystic carcinoma was diagnosed in 13 patients, squamous cell carcinoma in 5, typical carcinoid in 2, and leiomyoma and benign fibrous histiocytoma, in 1 each. There were 19 segmental resections with direct anastomosis, and 3 complex resections in which the carina was involved.

Results

One patient with tumor in the trachea and left main bronchus underwent resection through simultaneous bilateral thoracotomy and died. During 2 to 17 years of follow-up, 2 patients died of unrelated disease, 2 died of metastases, and 1 is receiving radiotherapy for recurrence. Sixteen patients are well and free of tumor.

Conclusions

Complete resection of all neoplastic tissue is mandatory, but benign and low-grade malignant tumors should be resected conservatively with preservation of lung parenchyma. Options for treatment of neoplasms involving trachea and left bronchus should include resection of the neoplasm in two stages, thus minimizing trauma of each operation.

Section snippets

Patients and Methods

Between 1975 and 1994, 22 patients with primary neoplasms of the proximal tracheobronchial tree were treated by resection. There were 13 men and 9 women, ranging in age from 26 to 76 years.

The trachea was involved in all instances. The neoplasm extended into the left bronchus in one patient and invaded the carina and the right bronchus in one. In one patient the tumor arose from the right tracheal wall between the origin of an anomalous tracheal bronchus and the right main bronchus.

Symptoms and

Results

There was one operative death (patient 2). Follow-up has been maintained on all surviving patients. Of the 12 survivors with adenoid cystic carcinoma, 1 patient died of myocardial infarction without recurrent tumor 3 years after the operation, 2 patients died of metastatic spread 5 years 2 months and 7 years after the operation (both did not receive postoperative radiotherapy); and 9 patients are living without tumor (all irradiated) from 4 years to 12 years 2 months after the resection.

Of the

Comment

Delays in diagnosis of tracheal tumors occur commonly because the large lumen of the trachea prevents early occlusion. Belsey [1] determined that 75% of the tracheal lumen must be occluded before symptoms occur. In addition, nonspecific respiratory symptoms are easily confused with other pulmonary diseases. Several of our patients were treated by their family physicians for supposed infection or asthma, with delay of their clinical workup. Some of our patients were so managed for up to 6 months

References (20)

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