Predictors for Postoperative Complications After Tracheal Resection

Bibas, Benoit Jacques; Terra, Ricardo Mingarini; Oliveira, Ana; Tamagno, Mauro Federico Luis; Minamoto, Hélio; Cardoso, Paulo Francisco Guerreiro; Pêgo-Fernandes, Paulo Manuel

doi:10.1016/j.athoracsur.2014.03.019

Cited by 88 publications

(103 citation statements)

References 14 publications

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“…Furthermore, (laryngo)tracheal surgery appears safe, with a mortality of 0.8% in our series, which is in accordance with a surgical mortality of 0% to 2% as reported in the literature (5,(14)(15)(16)(17)(18)(19).…”

Section: Discussionsupporting

confidence: 78%

“…This strengthens the notion that LTR is a more challenging and complex procedure with less predictable outcomes when compared to STR (6,14,15). This is probably due to the anatomical challenges in the laryngeal zone, caused by a very narrow tracheal lumen in this region, the attachment of the vocal cords to the arytenoids, as well as the branches of the RLN which are attached to the lateral sides of the cricoid.…”

Section: Discussionmentioning

confidence: 67%

“…From our point of view, voice function seems to be an overlooked aspect after tracheal surgery. Just five medium-sized to large case-series (including more than 50 patients) mentioned abnormal voice outcome without RLN palsy after tracheal surgery (15)(16)(17)(18)26). Only one study with 32 patients quantified voice outcome from good to poor (25).…”

Section: Discussionmentioning

confidence: 99%

“…Most reports focus on post-procedural tracheal lumen patency or decannulation rates as the definition for treatment success (5,7,14,15,18,20). However, functional outcome should be considered equally important, especially from the patients' point of view.…”

Section: Discussionmentioning

confidence: 99%

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Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Timman¹,

Schoemaker²,

Li³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: In this study we focus on functional outcomes after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis, with a specific interest in the impact of laryngeal involvement on postoperative outcome.Methods: All patients who underwent (laryngo)tracheal surgery for benign pathology between 1996 and 2017 in our centre were included in this retrospective study. Surgical outcomes were procedural success rate, and airway-and voice-related complications. Functional results were assessed using (standardized) questionnaires for quality of life, sensation of dyspnea, swallowing function, and voice perception.Results: Of 119 consecutive patients, 47 underwent laryngotracheal resection and reconstruction and 72 underwent segmental tracheal surgery (78% with an end-to-end tracheal anastomosis and 22% with a cricotracheal anastomosis). Overall success rate was 92% and was similar for all groups, with an overall significant improvement in quality of life when compared to the preoperative situation. However, after laryngotracheal surgery, airway-related complications were more common when compared to segmental resections with an end-to-end tracheal anastomosis (30% versus 7%, P=0.003). Additionally, early voice alterations without recurrent nerve palsy were reported twice as often (34% versus 16%, P=0.034) and voice quality experienced during follow-up was significantly worse when compared to segmental resections.Overall response rate to the questionnaires on functional outcome was 63%.Conclusions: (Laryngo)tracheal surgery is safe and beneficial, with significant functional improvement during mid-and long-term follow-up. However, laryngeal involvement is a predictor for increased surgical airway-related complications. Additionally, voice alterations without recurrent nerve palsy are far more common after laryngotracheal resection and are a serious handicap. This aspect is underexposed in current literature and deserves further attention during preoperative counseling and patient follow-up. However, the results on functional outcome of this current study should be interpreted with caution due to the somewhat low response rate of the questionnaires.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Timman¹,

Schoemaker²,

Li³

et al. 2018

Ann. Cardiothorac. Surg.

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“…Larger fistulas (!10 mm) usually required concomitant tracheal resection and reconstruction. Tracheal anastomosis was performed with a continuous running suture of polydioxanone 4-0 (PDS II; Ethicon, Bridgewater, NJ) in the membranous wall and separated sutures of polyglactin 3-0 (Vicryl; Ethicon) in the cartilaginous wall [6]. Laryngotracheal reconstruction was performed according to the technique described by Pearson and colleagues [7] and Grillo and colleagues [8].…”

Section: Operative Managementmentioning

confidence: 99%

Surgical Management of Benign Acquired Tracheoesophageal Fistulas: A Ten-Year Experience

Bibas

Cardoso

Minamoto

et al. 2016

The Annals of Thoracic Surgery

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Factors Associated With Dysphagia in Patients Undergoing Tracheal Resection

Lui

Bensoussan

Pei

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportancePatients undergoing tracheal resection commonly experience dysphagia postoperatively, and the patient factors that predict severity and duration of symptoms are currently unclear.ObjectiveTo determine the association of patient and surgical factors on postoperative dysphagia in adult patients undergoing tracheal resection.Design, Setting, and ParticipantsThis was a retrospective cohort study of patients undergoing tracheal resection at 2 tertiary academic centers from February 2014 to May 2021. The centers included LAC+USC (Los Angeles County + University of Southern California) Medical Center and Keck Hospital of USC, both tertiary care academic institutions. Patients involved in the study underwent a tracheal or cricotracheal resection.ExposuresTracheal or cricotracheal resection.Main Outcomes and MeasuresThe main outcome was dysphagia symptoms as measured by the functional oral intake scale (FOIS) on postoperative days (PODs) 3, 5, and 7, on the day of discharge, and at the 1-month follow-up visit. Demographics, medical comorbidities, and surgical factors were evaluated for association with FOIS scores at each time period using Kendall rank correlation and Cliff delta.ResultsThe study cohort consisted of 54 patients, with a mean (SD) age of 47 (15.7) years old, of whom 34 (63%) were male. Length of resection segment ranged from 2 to 6 cm, with a mean (SD) length of 3.8 (1.2) cm. The median (range) FOIS score was 4 (1-7) on PODs 3, 5, 7. On the day of discharge and at 1-month postoperative follow-up, the median (range) FOIS score was 5 (1-7) and 7 (1-7), respectively. Increasing patient age was moderately associated with decreasing FOIS scores at all measured time points (τ = −0.33; 95% CI, −0.51 to −0.15 on POD 3; τ = −0.38; 95% CI, −0.55 to −0.21 on POD 5; τ = −0.33; 95% CI, −0.58 to −0.08 on POD 7; τ = −0.22; 95% CI, −0.42 to −0.01 on day of discharge; and τ = −0.31; 95% CI, −0.53 to −0.09 at 1-month follow-up visit). History of neurological disease, including traumatic brain injury and intraoperative hyoid release, was not associated with FOIS score at any of the measured time points (δ = 0.03; 95% CI, −0.31 to 0.36 on POD 3; δ = 0.11; 95% CI, −0.28 to 0.47 on POD 5, δ = 0.3; 95% CI, −0.25 to 0.70 on POD 7; δ = 0.15; 95% CI, −0.24 to 0.51 on the day of discharge, and δ = 0.27; 95% CI, −0.05 to 0.53 at follow-up). Resection length was also not correlated with FOIS score with τ ranging from −0.04 to −0.23.Conclusions and RelevanceIn this retrospective cohort study, most patients undergoing tracheal or cricotracheal resection experienced full resolution of dysphagia symptoms within the initial follow-up period. During preoperative patient selection and counseling, physicians should consider that older adult patients will experience greater severity of dysphagia throughout their postoperative course and delayed resolution of symptoms.

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Predictors for Postoperative Complications After Tracheal Resection

Cited by 88 publications

References 14 publications

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Surgical Management of Benign Acquired Tracheoesophageal Fistulas: A Ten-Year Experience

Factors Associated With Dysphagia in Patients Undergoing Tracheal Resection

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