Tracheal Autotransplantation for Functional Reconstruction of Extended Hemilaryngectomy Defects: A Single-Center Experience in 30 Patients

Loos, Elke; Meulemans, Jeroen; Vranckx, Jan; Poorten, Vincent Vander; Delaere, Pierre

doi:10.1245/s10434-015-5033-y

Cited by 23 publications

(16 citation statements)

References 22 publications

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“…The trachea is then re-transplanted orthotopically in the airway position. The first series of patients undergoing allogenic tracheal transplantation reports from 2016 where patients with longsegment tracheal stenosis were treated successfully (10). The main hurdle in allogenic transplantation remains the initial requirement of immunosuppressive therapy until the transplant is vascularized.…”

Section: Review Articlementioning

confidence: 99%

Aortic allografts: final destination?—a summary of clinical tracheal substitutes

Siddiqi¹,

Wit²,

Heide³

et al. 2018

J. Thorac. Dis.

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The patient population in desperate need for an airway substitute are individuals with long segment tracheal defects that are considered, technically, inoperable. Regardless of the underlying etiology, benign or malignant growing processes, this patient category enters a palliative setting or require tracheal transplantation. Different airway substitutes have been categorized by Grillo as follows; tracheal transplantation, autogenous tissue, non-viable tissue, tissue-engineering and foreign materials. These fields have been explored in the past in animal models and in clinical patients. Research on airway replacement has been exposed to a level of controversies in the past years. The field has been turbulent and apocryphal. In particular, the area of tissue-engineering using stem cells has suffered from a major set-back leaving scientists, clinicians and ethical committees skeptical. Recently, a hopeful study emerged using aortic allografts as tracheal substitutes in patients with airway defects. The initial results seem promising and reliable. The developments of the field at this point seem striking and hopeful. The focus of this review is to shed light on developments in the field of aortic allografts as substitute for tracheal replacement.

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Section: Review Articlementioning

confidence: 99%

Aortic allografts: final destination?—a summary of clinical tracheal substitutes

Siddiqi¹,

Wit²,

Heide³

et al. 2018

J. Thorac. Dis.

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“…4F). [50][51][52][53][54][55][56][57] Daily triple immunosuppression is usually initiated upon heterotopic implantation of the graft and continues for 15-18 months following orthotopic transplantation, using tacrolimus (Prograf), mycophenolate mofetil (Cellcept), and methylprednisolone. 54 It has also been found that removal of the trachealis muscle and creation of intercartilaginous incisions both aid neovascularization within the graft, although it has yet to be determined how these alterations affect the overall mechanical properties of the graft.…”

Section: Treated or Preserved Allograftsmentioning

confidence: 99%

“…The main complications associated with this method are stricture, 52 tracheocutaneous fistula occurring in the forearm, 55 and infection at both the forearm wound site and following orthotopic tranplantation. 55 There are also reported cases where the method failed completely when the graft necrosed in the forearm. 52 The Leuven protocol is ongoing in the clinic, with the most recent case report in 2016 ( Fig.…”

Section: Engineered Tracheal Replacements Over Timementioning

confidence: 99%

The History of Engineered Tracheal Replacements: Interpreting the Past and Guiding the Future

Greaney

Niklason

2021

Tissue Engineering Part B: Reviews

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The development of a tracheal graft to replace long-segment defects has thwarted clinicians and engineers alike for over 100 years. To better understand the challenges facing this field today, we have consolidated all published reports of engineered tracheal grafts used to repair long-segment circumferential defects in humans, from the first in 1898 to the most recent in 2018, totaling 290 clinical cases. Distinct trends emerge in the types of grafts used over time, including repair using autologous fascia, rigid tubes of various inert materials, and pretreated cadaveric allografts. Our analysis of maximum clinical follow-up, as a proxy for graft performance, revealed that the Leuven protocol has a significantly longer clinical follow-up time than all other methods of airway reconstruction. This method involves transplanting a cadaveric tracheal allograft that is first prevascularized heterotopically in the recipient. We further quantified graft-related causes of mortality, revealing failure modes that have been resolved, and those that remain a hurdle, such as graft mechanics. Finally, we briefly summarize recent preclinical work in tracheal graft development. In conclusion, we synthesized top clinical care priorities and design criteria to inform and inspire collaboration between engineers and clinicians toward the development of a functional tracheal replacement graft.

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“…However, in selected cases, salvage conservation laryngeal surgery may be considered as a more functional alternative to TL. This encompasses both open surgical techniques such as horizontal supraglottic laryngectomy, vertical partial laryngectomy, supracricoid partial laryngectomy, and extended hemilaryngectomy with tracheal autotransplantation on the one hand and transoral techniques such as transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) on the other [6, 7]. Whereas open salvage conservation laryngeal surgery has good oncologic outcomes in experienced hands, its widespread use is hampered due to the technical complexity of the procedures, the lack of expertise in most centers, unpredictable functional outcomes regarding voice and swallowing, high rates of complications (fistula formation and aspiration pneumonia), and long hospitalization time [7, 8••].…”

Section: Introductionmentioning

confidence: 99%

Salvage Transoral Laser Microsurgery for Radiorecurrent Laryngeal Cancer: Indications, Limits, and Outcomes

Meulemans

Delaere

Nuyts

et al. 2017

Curr Otorhinolaryngol Rep

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Purpose of ReviewThe aim of this report is to identify relevant literature reports on salvage transoral laser microsurgery (TLM); to consider its oncologic and functional outcomes, as well as reported complications; and to address indications and limitations of salvage TLM.FindingsThe weighted average of local control after first salvage TLM was 57%. Repeated TLM procedures for second or third recurrences were required in up to 41% of cases, resulting in a weighted average of local control with TLM alone of 67%. The rate of definite laryngeal preservation was 73%. The ultimate local control rate, including cases that required total laryngectomy, was 90%. The overall complication rate after salvage TLM was 14%.SummarySalvage TLM of radiorecurrent laryngeal cancer yields excellent oncologic outcomes. Serious complications are scarce, hospitalization times are short, and functional outcomes in terms of voice and swallowing are favorable when compared to open conservation laryngeal surgery. The key to success is an optimal patient selection.

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Tracheal Autotransplantation for Functional Reconstruction of Extended Hemilaryngectomy Defects: A Single-Center Experience in 30 Patients

Cited by 23 publications

References 22 publications

Aortic allografts: final destination?—a summary of clinical tracheal substitutes

Aortic allografts: final destination?—a summary of clinical tracheal substitutes

The History of Engineered Tracheal Replacements: Interpreting the Past and Guiding the Future

Salvage Transoral Laser Microsurgery for Radiorecurrent Laryngeal Cancer: Indications, Limits, and Outcomes

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