Tracheal Resection

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Tracheal resection and primary reanastomosis for tracheal tumors and stenosis is a well-described procedure. ^{[1, 2, 3, 4]}  It is most commonly indicated for postintubation lesions but is also performed for malignancies, secondary tracheal tumors, and tracheoesophageal and tracheal innominate fistulas.

Approximately half of the trachea can be safely removed with a low incidence of anastomotic complications. ^{[2, 3, 4, 5]} Because of the lack of suitable replacement material for the trachea, various mobilization and release maneuvers have been demonstrated to increase the length of the tracheal resection by elevating the carina. These include hilar, suprahyoid, and suprathyroid laryngeal release ^{[2, 6, 7]} ; anterior and posterior digital tracheal dissection; and constant neck flexion.

Constant neck flexion by a suture between the skin of the point of the chin and midline of the chest over the manubrium has been widely considered paramount to successful tracheal resections. An orthosis has also been used as a more comfortable alternative to utilizing the traditional suture between the chin and the midline of the chest over the manubrium. ^[8] The use of tracheal retention sutures on the proximal and distal-lateral edges of the anastomotic line has also been suggested as an alternative to the traditional chin suture for reducing tension on the anastomosis. ^[9]

Thoracoscopic tracheal resections, though not common at present, have also been described. ^[10]

Postintubation lesions are the most common indication for tracheal resection and reconstruction. Malignancies (including, predominantly, squamous cell carcinoma and adenocystic carcinoma) also remain an indication for resection. ^{[11, 12]} Other indications include secondary tracheal tumors and tracheoesophageal and tracheal innominate fistulas. ^[13]  (See the images below.)

Contraindications for tracheal resection and reconstruction include the following:

The trachea is nearly but not quite cylindrical and is flattened posteriorly. In cross-section, it is D-shaped, with incomplete cartilaginous rings anteriorly and laterally, and a straight membranous wall posteriorly. The trachea measures about 11 cm in length and is chondromembranous. This structure starts from the inferior part of the larynx (cricoid cartilage) in the neck, opposite C6, and extends to the intervertebral disk between T4 and T5 in the thorax, where it divides at the carina into the right and left bronchi.

For more information about the relevant anatomy, see Trachea Anatomy.

Mathisen DJ. Tracheal Resection and Reconstruction: How I Teach It. Ann Thorac Surg. 2017 Apr. 103 (4):1043-1048. [Medline].

Liberman M, Mathisen DJ. Surgical anatomy of the trachea and techniques of resection and reconstruction. Shields TW, LoCicero J III, Reed CE, Feins RH, eds. General Thoracic Surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. Vol 1: 955-66.

Rea F, Zuin A. Tracheal resection and reconstruction for malignant disease. J Thorac Dis. 2016 Mar. 8 (Suppl 2):S148-52. [Medline]. [Full Text].

Allen MS. Surgery of the Trachea. Korean J Thorac Cardiovasc Surg. 2015 Aug. 48 (4):231-7. [Medline]. [Full Text].

Mohsen T, Abou Zeid A, Abdelfattah I, Mosleh M, Adel W, Helal A. Outcome after long-segment tracheal resection: study of 52 cases. Eur J Cardiothorac Surg. 2018 Jan 16. [Medline].

Montgomery WW. The surgical management of supraglottic and subglottic stenosis. Ann Otol Rhinol Laryngol. 1968 Jun. 77 (3):534-46. [Medline].

Dedo HH, Fishman NH. Laryngeal release and sleeve resection for tracheal stenosis. Ann Otol Rhinol Laryngol. 1969 Apr. 78 (2):285-96. [Medline].

Mueller DK, Becker J, Schell SK, Karamchandani KM, Munns JR, Jaquet B. An alternative method of neck flexion after tracheal resection. Ann Thorac Surg. 2004 Aug. 78 (2):720-1. [Medline].

Karapolat S, Turkyilmaz A, Seyis KN, Tekinbas C. A Comfortable Solution To Tracheal Anastomosis Protection: Tracheal Retention Sutures. Heart Lung Circ. 2018 Apr. 27 (4):e39-e41. [Medline].

Hung WH, Chen HC, Huang CL, Wang BY. Thoracoscopic Tracheal Resection and Reconstruction with Single-Incision Method. Ann Thorac Surg. 2018 Mar 3. [Medline].

Jiao W, Zhu D, Cheng Z, Zhao Y. Thoracoscopic tracheal resection and reconstruction for adenoid cystic carcinoma. Ann Thorac Surg. 2015 Jan. 99 (1):e15-7. [Medline].

Piazza C, Del Bon F, Barbieri D, Grazioli P, Paderno A, Perotti P, et al. Tracheal and Crico-Tracheal Resection and Anastomosis for Malignancies Involving the Thyroid Gland and the Airway. Ann Otol Rhinol Laryngol. 2016 Feb. 125 (2):97-104. [Medline].

Grillo HC. Development of tracheal surgery: a historical review. Part 2: Treatment of tracheal diseases. Ann Thorac Surg. 2003 Mar. 75 (3):1039-47. [Medline].

Carinal resection. CTSNet. Available at https://www.ctsnet.org/article/carinal-resection. July 1, 2008; Accessed: March 7, 2018.

Villanueva C, Milder D, Manganas C. Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection. Heart Lung Circ. 2015 Jul. 24 (7):e86-8. [Medline].

Grillo HC, Mathisen DJ. Primary tracheal tumors: treatment and results. Ann Thorac Surg. 1990 Jan. 49 (1):69-77. [Medline].

Mueller DK, Becker J, Schell SK, Karamchandani KM, Munns JR, Jaquet B. An alternative method of neck flexion after tracheal resection. Ann Thorac Surg. 2004 Aug. 78 (2):720-1. [Medline].

Grillo HC. Development of tracheal surgery: a historical review. Part 1: Techniques of tracheal surgery. Ann Thorac Surg. 2003 Feb. 75 (2):610-9. [Medline].

Dale K Mueller, MD Co-Medical Director of Thoracic Center of Excellence, Chairman, Department of Cardiovascular Medicine and Surgery, OSF Saint Francis Medical Center; Cardiovascular and Thoracic Surgeon, HeartCare Midwest, Ltd, A Subsidiary of OSF Saint Francis Medical Center; Section Chief, Department of Surgery, University of Illinois at Peoria College of Medicine

Dale K Mueller, MD is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, American Medical Association, Chicago Medical Society, Illinois State Medical Society, International Society for Heart and Lung Transplantation, Society of Thoracic Surgeons, Rush Surgical Society

Disclosure: Received consulting fee from Provation Medical for writing.

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women’s Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Tracheal Resection

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