Long-term results of laryngotracheal resection for benign stenosis☆

Abstract

Objective: We report the long-term results of our 16-year experience with laryngotracheal resection for benign stenosis. Methods: Between 1991 and 2006, 35 consecutive patients (19 males, 16 females) underwent laryngotracheal resection for subglottic postintubation (32) or idiopathic (3) stenosis. Mean age was 43 years (range 14-71). At the time of surgery 13 patients presented with tracheostomy and 7 with a Dumon stent. The upper limit of the stenosis was from 0.6 to 1.5 cm below the vocal cords. The length of airway resection ranged between 1.5 and 6 cm. Suprahyoid release was performed in two patients and pericardial release in one. Nine patients had psychiatric and/or neurological post-coma disorders. Mean follow-up is over 5 years (61 months; range 3-194). Results: There was no perioperative mortality. Thirty patients (85.7%) had excellent or good anatomic and functional results. Four patients (11.4%) presented restenosis at a distance of 25-110 days from the operation. Restenosis was successfully treated by endoscopic procedures in all four patients. One patient (2.9%) presented anastomotic dehiscence that required temporary tracheostomy closed after 1 year with no sequelae. Three patients (8.4%) had wound infection. Long-term follow-up was uneventful also in patients who had early complications. Conclusions: Long-term follow-up confirms that laryngotracheal resection is the definitive curative treatment for benign subglottic stenosis. Surgical complications can be successfully managed by non-operative procedures. Despite the occurrence of early complications, excellent and stable results can still be obtained at long term. #

Tracheal surgery

“…Some surgeons prefer to extubate the patient in the operative room at the end of the tracheal reconstruction. We, as other authors [10,14] commonly leave a naso-tracheal tube uncuffed in site, with the distal end beyond the anastomosis for 24 hours postoperatively. This tube allows adequate toilette of the airway soon after the operation protecting the anastomosis.…”

“…In our experience [10], a small calibre (4-4.5) endotracheal tube is passed through the stenosis, and this is usually sufficient for adequate ventilation until the trachea is exposed and incised allowing cross-field intubation. Occasionally the tube can be placed immediately above the stenosis.…”

“…The major series of laryngo-tracheal resection published in the international literature report a high rate of good or excellent results, with low mortality (generally under 1-2%), supporting the role of surgery as the treatment of choice [10,[12][13][14][15][16][17].…”

“…We have recently published our experience of laryngo-tracheal resection for benign stenosis over a 16-year period reporting long-term results (mean follow-up 61 months) [10]. In a series of 35 consecutive patients, immediate excellent or good anatomic and functional results were observed in 85.7% of the cases.…”

Cold snare resection for the treatment of benign airway lesions

“…In the past 20 years, the endoscopic techniques for diagnosis and treatment developed rapidly, and endoscopic interventional therapy has played exceedingly important roles in the treatment of airway stenosis due to its short operation time, reduced pain, and the immediate relief of dyspnea and anoxia. 4 The main endoscopic interventions include high-frequency electric snare, stent placement, balloon dilatation, laser ablation, argon plasma coagulation (APC), and cryotherapy. 5 By the most common conservative methods for the treatment of airway benign neoplasms, mechanical debulking is achieved hot or cold biopsy forceps and high-frequency electric snare.…”