Perioperative outcome and predictors of success after tracheal resection

Tracheal stenosis (TS) leads to progressive ventilatory restriction and endoscopic interventions for symptomatic relief have often palliative character. Resection of the narrowed segment can result in sustainable long-term outcome. We analyzed our experience in tracheal reconstructive surgery with focus on perioperative management and procedural morbidity.

We conducted a retrospective study of prospectively obtained clinical data from patients undergoing tracheal surgery at the Thoraxklinik Heidelberg between July 2000 and September 2023. Aim of the study was to identify clinical variables with impact on the perioperative course and individual outcome.

138 patients underwent tracheal surgery for TS in our department. Main indications were post-tracheostomy stenosis (n = 77, 55.8%), malignant tracheal tumor (n = 27, 19.6%) and idiopathic tracheal stenosis (n = 22, 15.9%). The latter was observed more frequently in females (95.2%, p < 0.001). Most patients were extubated in the surgical theatre (83.3%) or immediately in the early postoperative period (< 24 h, 8.7%). No 30-day or 90-day mortality was observed. 13 patients (9.4%) developed symptomatic tracheal restenosis. Only seven patients (5.1%) required endoscopic intervention. Postoperative prolonged ventilation (> 24 h postop) was associated with development of anastomotic insufficiency and wound infections. Female sex and history of idiopathic stenosis were significant risk factors for recurrent stenosis.

Reconstructive surgery for TS results in favorable functional outcome in selected patients and is associated with a low morbidity and mortality. Patient selection and perioperative management requires an experienced multidisciplinary team.