Cricotracheal resection for adult subglottic stenosis: Factors predicting treatment failure

Abstract

Objectives/Hypothesis Identify predictors of decannulation failure after cricotracheal resection (CTR) and thyrotracheal anastomosis (TTA) in patients with subglottic stenosis (SGS). Study Design Retrospective cohort study. Methods Charts of patients undergoing CTR and TTA for SGS at the University Health Network, Toronto, Ontario, Canada between 1988 and 2017 were reviewed. Patient, pathology, treatment, and outcome data were collected. The end points for statistical analysis were development of restenosis and permanent tracheostomy. Results One hundred fourteen patients (n = 114) were eligible for inclusion in this review. The mean age at primary resection was 46.9 years, 95 (83%) were females, and 19 (17%) were males. The rate of restenosis and permanent tracheostomy was 13% and 5%, respectively. Sixty‐two patients (54%) underwent a CTR and TTA, and 52 patients (46%) underwent a CTR, laryngofissure, and TTA. Traumatic stenosis (odds ratio [OR] = 10.3, P = .017), longer T‐tube duration (OR = 1.2, P = .011), combined glottic/subglottic stenosis (OR = 10.47, P = .010), start of the stenosis at the vocal cords (OR = 6.6, P = .029), postoperative minor complications (OR = 13.6, P = .028), and need for repeat surgery (OR = 44.1, P < .001) were associated with an increased risk of requiring permanent tracheostomy. Conclusions CTR and TTA are excellent surgical approaches for adult patients with subglottic stenosis. In this study, 5% of patients required permanent tracheostomy. Factors predicting treatment failure include traumatic stenosis, longer T‐tube duration, combined glottic/subglottic stenosis, start of stenosis at the level of vocal cords, postoperative minor complications, and need for repeat surgery. Level of Evidence 4 Laryngoscope, 130:1634–1639, 2020

Tracheal and laryngotracheal resections and reconstructions—a single-centre experience

“…We consider the maximum length of a safe resection to be about 5 cm, or half of the tracheal length. Reported success rates in the literature for TR and CTR range from 65% to >95% (8)(9)(10)(11)(12)(13)(14)19,23,24). In our cohort, 33 (75%) patients did not require reoperations or postoperative interventions, which falls in the range of previous reported success rates.…”

“…This area has a total population of over two million people (36% of Finland's population), which further highlights how infrequently this surgery is performed. Therefore, due to their rare nature, these surgical procedures should be further centralized, as they require a multidisciplinary approach and are associated with a significant complication rate (1,3,8,(10)(11)(12)(13)(14)23).…”

“…The aim of a successful TR or CTR is the removal of the pathologic section of the (laryngo)trachea and reestablishment of a functioning airway, as well as achieving a tension free anastomosis (1)(2)(3)(12)(13)(14)(15)(16)(17). We consider the maximum length of a safe resection to be about 5 cm, or half of the tracheal length.…”

“…Surgical resection has proven to be the most effective long-term treatment in managing airway stenoses, with at its best reported success rates of up to 95% with minimal morbidity, as it provides the opportunity of re-establishing a healthy airway by removing the pathologic section (8)(9)(10)(11)(12)(13). TR and CTR are utilized in the treatment of primary tracheal and subglottic tumors.…”

Duration of stenting with Montgomery T-tubes in severe laryngotracheal stenosis: does it matter?

“…13 However, in a recent study, Jethwa et al, in 2019, while studying factors predicting treatment failure in 114 patients with subglottic stenosis who underwent cricotracheal resection with stenting, concluded that longer T-tube duration was associated with higher risk of permanent tracheostomy. 14 They reported 95 per cent success (decannulation) after cricotracheal resection and thyrotracheal anastomosis. Patients had stenting for longer periods (65.1 days) if they had extensive or multiple levels of stenosis or co-morbidities that increased chances of failure.…”