[Tracheal reconstruction]

Progress in anesthesia, surgical techniques, and understanding of the pathophysiology of the trachea has made tracheal reconstruction a safe operative procedure. As of December 1999, 109 patients had undergone tracheal reconstruction at the author's institution. Diseases included: tumorous lesions in 83, consisting of 13 primary tracheal tumors and 70 carcinomatous invasions originating from adjacent organs such as thyroid cancer; and 26 benign stenotic lesions such as postintubation stenosis in 15, posttraumatic stenosis in 9, and congenital and tuberculous stenosis in one case each. Among the 109 patients, resection of the trachea and end-to-end anastomosis were performed in 105 patients and partial resection of the trachea with direct closure was done in 4 patients. Complications at anastomosis were seen in 5 patients, with stenosis at anastomosis in 2, suture failure in 2, and malacia in one. The most frequent lesion seen at our institution was thyroid carcinoma invading the trachea in 64 patients. The number of tracheal rings resected ranged from 1 to 11, with an average of 6. Complete resection was done in 34 of these 64 patients, and their 5- and 10-year survival rates were 79.4% and 75.6%. In 30 patients in whom resection was incomplete the 5- and 10-year survival rates were 52.8% and 35.5%, respectively. Tracheal reconstruction for another tumorous and non tumorous origins improved QOL of patients suffering from cough, sputum, hemosputum and dyspnea, and it was even life saving.