Update of Long-Term Outcomes After Cricotracheal Resection for Idiopathic Subglottic Stenosis

Idiopathic subglottic stenosis (iSGS) is a rare disease in which patients develop dyspnea from recurrent tracheal granulation scar. We present our long-term outcomes after crico-tracheal resection (CTR) for iSGS at a high-volume tertiary care center. We update our previous report in 2018 with seven additional years of follow-up.

A review was conducted with iSGS patients who underwent CTR between 1999 and 2017. Diagnosis of iSGS was based on history and bronchoscopy exam. Recurrence of iSGS was evaluated using survivability and the Kaplan-Meier curve. Management of recurrence post-CTR was investigated with Pearson correlation analysis.

Sixty-one patients with iSGS underwent CTR. Our population was 98% female. Twenty (33%) patients developed recurrence after CTR. The mean time to recurrence was 13.8 years (range = 0.8-16.3). Seven (11%) patients had not recurred up to 21.9 years post-CTR. There was a negative correlation (-0.45, p = 0.046) between age at recurrence and number of procedures per year to treat recurrent stenosis. Six (10%) patients were deceased from unrelated causes at follow-up and on average 6 years post-CTR (range = 0.8-15.8). One patient recurred prior to her death.

Our 2018 report included a mean recurrence time of 12.5 years (range = 0.8-14.3). This follow-up showed an even longer time to recurrence (average = 13.8 years). CTR is associated with a low recurrence rate of stenosis. Older patients may be better candidates for CTR than younger patients. Further research should investigate risk factors that predispose patients to recurrence after CTR.