Analysis of mid-to-long term changes of tracheal volume after tracheal reconstruction

Tracheal reconstruction is typically performed in patients with defects caused by invasive thyroid carcinoma, tracheal cancer, or tracheal fistula. Various tracheal reconstructive techniques have been reported. However, there are few reports on the long-term outcomes of tracheal reconstruction. At our institution, soft tissue reconstruction was performed in patients with tracheal cartilage defects involving 20-40%, whereas rigid reconstruction was performed in those with 40-80% defects. This study analyzed mid- to long-term changes in tracheal volume after soft tissue and rigid reconstructions, as well as the volume changes of transplanted costal cartilage in rigid reconstructions.

Between April 2010 and March 2023, ten patients underwent tracheal reconstruction at Saitama Cancer Center (Saitama, Japan). Five patients with a 20-40% tracheal cartilage defect (Tr 1a) underwent soft tissue reconstruction, and five patients with a 40-80% tracheal cartilage defect (Tr 2b) underwent rigid reconstruction. The patients' medical records were retrospectively reviewed. Changes in reconstructed tracheal lumen volume and transplanted costal cartilage volume were analyzed.

All ten patients successfully underwent two-stage reconstruction without major complications. Although the soft tissue reconstruction group exhibited variable changes in tracheal lumen volume, the volume generally increased over five years with no airway stenosis. In contrast, the rigid reconstruction group maintained stable tracheal lumen volumes, and costal cartilage grafts showed slight early resorption followed by stabilization.

No cases of airway stenosis were observed in either the soft tissue or rigid reconstruction groups. For rigid reconstruction, the combination of costal cartilage and forearm flaps effectively maintained tracheal patency. Our preliminary findings suggest that costal cartilage may represent a suitable graft material for rigid tracheal reconstruction.