Idiopathic Subglottic Stenosis: Factors Affecting Outcome After Single-Stage Repair

Abstract

Single-stage reconstructive surgery resulted in 96% good-to-excellent results. Recalcitrant stenosis developed in 4% of patients. Stents, postoperative edema, mitomycin use, and vocal cord involvement are risks for recurrence. Recurrence was related to reactivation of disease in 14 patients and to technical problems in 6 patients.

Outcomes after cricotracheal resection for idiopathic subglottic stenosis

“…We were unable to find any association between preoperative comorbidities, amount of preoperative treatment, or size and length of stenosis with rate of recurrence. Patients who underwent CTR and were not actively taking a PPI had increased odds of recurrence; however, this was not statistically significant, which correlates with prior large studies . Given our single institution cohort, risk factors for recurrence remain elusive.…”

“…Recurrence was the second most common complication after CTR, representing eight (13.1%) patients. Interestingly, our recurrence rate after CTR is in between quoted recurrences at other single institutions . There are a few potential reasons for this disparity.…”

“…Important in the treatment paradigm is the utilization of a multimodality treatment plan . Cricotracheal resection has historically resulted in lower recurrence of iSGS when compared to endoscopic management but carries a more significant list of potential complications . This current study attempted to analyze outcomes of iSGS patients after CTR by a single surgeon at a single institution.…”

“…Although slightly counterintuitive, we feel that CTR can be a more viable option for patients living further away, despite the increased risks and associated complications. Most acute complications after CTR are seen when the patient is recovering from procedure in the hospital and can be managed appropriately . Historically, CTR is associated with less episodes and frequency of recurrence when compared to primary endoscopic management of iSGS .…”

Treatment of large tracheal defects after resection: Laryngotracheal release and tracheal replacement

“…The local tensile loads exerted on the anastomoses after resection were found to be 7.2 N when a length of 3 cm (equivalent to 13% of the total tracheal length) was removed, 13.6 N by 6 cm (26%), and 21.4 N by 9 cm (39%), respectively[2]. In a large series of 263 patients undergoing surgery for idiopathic subglottic stenosis 8.7% of patients experienced subsequent recurrence of stenosis[6]. …”