Reconstruction of Oncologic Trachea Defects: Classification, Algorithm, and Outcomes

To review our experience of tracheal reconstruction for various defects and provide an algorithm for reconstruction.

All tracheal reconstruction cases from May 2002 to December 2024 were identified. Patient characteristics, types of defects, methods of reconstruction, postoperative complications, and outcomes were analyzed.

Defects less than 4cm long were typically repaired in an end-to-end fashion (Type I, n = 72) and covered with a pedicled muscle flap, omentum, or local tissue. Longer defects (Type II) were reconstructed with a free radial forearm flap for lining with rigid prosthetic support (n=10). Type III defects (n=33) were those without a larynx. These were further classified into concurrent tracheal defects as part of a total laryngopharyngectomy (IIIa), tracheostoma recurrence after a previous total laryngectomy (IIIb), or a combined total laryngopharyngectomy, total esophagectomy and tracheal resection (IIIc). They were reconstructed with either a free anterolateral thigh (ALT) flap, radial forearm flap, or pedicled internal mammary artery perforator (IMAP) flaps. Only Type II and III defects were included for analysis in this study. Two patients died from innominate artery bleeds 3 and 6 weeks after surgery. Two patients died from multiple organ failure 2 months after surgery. Twenty-four patients ultimately succumbed to disease progression with a median survival of 22 months (range: 3 - 125 months). The remaining 15 patients were alive at their last follow-up (median: 27 months; range: 2 - 216 months).

Tracheal reconstruction, while technically challenging, may provide a reasonable quality of life and survival in otherwise non-resectable patients.