Outcomes after cricotracheal resection for idiopathic subglottic stenosis

Carpenter, Patrick; Pierce, Jenny L.; Smith, Marshall E.

doi:10.1002/lary.27263

Cited by 22 publications

(47 citation statements)

References 17 publications

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“…Although reports of patient complications after CTR are variable within the literature, our data appeared comparable with the reported 10% to 20% rate of anastomotic complications [26][27][28][29] and 5% to 10% rate of postoperative unilateral vocal fold paralysis. 26,27 Endoscopic Treatments A notable outcome of our study was the findings for ERMT. In this 3-year study, ERMT offered significantly improved disease control compared with ED (the most common treatment) with minimal association with voice function, particularly when compared with CTR.…”

Section: Treatment Advantages and Trade-offs Cricotracheal Resectionsupporting

confidence: 88%

“…Second, previous reports identified a significant rate of recurrent disease (10%-30%) among patients who underwent CTR that occurred from 5 to 10 years after the surgical procedure. [26][27][28] These outcomes were not observed in our cohort given the temporal scope of our study. Longer-term follow-up of patients who underwent CTR from our cohort will continue to address this question.…”

Section: Treatment Advantages and Trade-offs Cricotracheal Resectionmentioning

confidence: 63%

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Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis

Gelbard

Anderson

Berry

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. OBJECTIVE To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. DESIGN, SETTING, AND PARTICIPANTS In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. MAIN OUTCOMES AND MEASURES The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. RESULTS Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. CONCLUSIONS AND RELEVANCE In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.

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Section: Treatment Advantages and Trade-offs Cricotracheal Resectionsupporting

confidence: 88%

Section: Treatment Advantages and Trade-offs Cricotracheal Resectionmentioning

confidence: 63%

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis

Gelbard

Anderson

Berry

et al. 2020

JAMA Otolaryngol Head Neck Surg

Self Cite

119

178

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“…Treatment options for high‐grade LTS vary from endoscopic to open‐neck procedures . However, it has been reported that higher grade of stenosis purported a higher probability of its recurrence after endoscopic treatment, independently from the etiology of the stenosis itself .…”

Section: Introductionmentioning

confidence: 99%

“…This sets the background for a growing tendency in the last few decades toward open‐neck tracheal resection and anastomosis (TRA) or cricotracheal resection and anastomosis (CTRA) procedures . However, TRA and CTRA are both associated with significant postoperative morbidity, risk of failure, and functional impairments such as voice‐ and swallowing‐related problems . These potential adverse events following TRA/CTRA have motivated different authors to create new classification systems that enable precise identification of patients at risk for postoperative complications and failure of decannulation …”

Section: Introductionmentioning

confidence: 99%

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Fiz¹,

Monnier

Koelmel³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis Introduction and widespread use of cricotracheal resection and anastomosis (CTRA) as routine treatment for high‐grade benign laryngotracheal stenosis (LTS) led to the need for a new classification system that could accurately predict surgical outcomes by integrating crucial stenosis and patient‐related information. In 2015, the European Laryngological Society (ELS) proposed a new classification for benign LTS. We retrospectively tested it in adults treated at three referral centers to assess its reliability in predicting surgical outcomes. Study Design Retrospective cohort study. Methods We included 166 adults treated by open tracheal resection and anastomosis (TRA) and CTRA procedures, restaged according to the ELS classification evaluating grade of stenosis (I–IV, Myer‐Cotton), number of subsites involved, and presence of systemic comorbidities. We correlated these parameters with decannulation, number of retreatments, and complications. Results Final decannulation was predicted by a proposed ELS score ≥ IIIb, history of previous treatment, and length of resection (P < .05). Decannulation was achieved in 99% of patients without and in 88% of patients with surgical complications (P < .01). The incidence of surgical complications was related to the proposed ELS score (P < .01); an ELS score < IIIb showed a lower complication rate compared to patients with a ≥ IIIb score (32.8% vs. 57.7%, P < .01). Additional treatment was required in 73 (44%) patients (mean = 2.7 ± 2.2, range = 1–11). ELS score ≥ IIIb, length of resection, and occurrence of surgical complications predicted the number of such treatments (P < .05, P < .05, and P < .001, respectively). Conclusions ELS classification of benign LTS is able to accurately predict success in adult TRA/CTRA procedures and may be helpful in choice of therapy and patient counseling. Level of Evidence 2b Laryngoscope, 130:1640–1645, 2020

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“…Specifically, cricotracheal resection places the recurrent laryngeal nerves and the cricothyroid muscles and joint at risk, which may cause permanent voice change [17]. There is also a risk of stenosis recurrence in the long term [18] which appears to be associated with the extent of the resection that needs to be performed. Conversely, implanting distant epithelial cells within the airway frequently causes chronic problems with cough and mucus, which, for some patients, effectively replaces one chronic condition (recurrent stenosis) for another (chronic cough, and mucus retention and plugging).…”

Section: Introductionmentioning

confidence: 99%

Vocal fold fixation due to proximal stenosis progression complicating idiopathic subglottic stenosis

Nouraei

Dorman

Johnston

et al. 2019

Eur Arch Otorhinolaryngol

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Purpose This study examined the incidence and risk factors for vocal fold fixation due to proximal progression of idiopathic subglottic stenosis (ISS) over the course of serial treatments. Methods Records of 22 consecutive patients with ISS treated between 2004 and 2016 were retrospectively reviewed. Patient, stenosis, and treatment details were recorded. Cox regression was used to identify independent predictors of vocal fold fixation. Results All patients were female and mean age at diagnosis was 46 ± 7 years. In five patients, the stenosis was within 15 mm of the glottis at first treatment. Vocal fold fixation due to proximal stenosis progression occurred in seven (32%) patients. It led to permanent hoarseness due to unilateral vocal fold fixation in two patients and caused airway compromise due to bilateral vocal fixation in two other patients. No airway-related deaths occurred and no patient required a tracheostomy. Stenosis incision using coblation or potassium titanyl phosphate laser, and an initial glottis-to-stenosis (GtS) distance < 15 mm significantly increased the risk of proximal stenosis progression on univariable analysis. Conclusion Vocal fold fixation due to proximal stenosis progression is a significant complication of idiopathic subglottic stenosis and causes permanent voice and/or airway sequelae. It should be actively looked for and documented every time a patient is assessed. If a reduction in the GtS distance is observed, definitive surgery should be promptly considered before proximal stenosis progression compromises the efficacy and safety of definitive treatment or, worse, causes vocal fold fixation.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Outcomes after cricotracheal resection for idiopathic subglottic stenosis

Abstract: 4. Laryngoscope, 128:2268-2272, 2018.

Cited by 22 publications

References 17 publications

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Vocal fold fixation due to proximal stenosis progression complicating idiopathic subglottic stenosis

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