D A Sharpe1, K Moghissi. 1. Humberside Cardiothoracic Surgical Centre, Castle Hill Hospital, Cottingham, North Humberside, England.
Abstract
OBJECTIVE: To assess early and long term (>5 years) results of tracheal resection and reconstruction. PATIENTS AND METHODS: Eighty-two patients amongst 144 with a variety of tracheal lesions, undergoing resection and reconstruction referred to a single surgeon. A retrospective study, the patients were grouped into: Group 1 neoplastic (n = 55) subdivided into: primary tracheal malignancy (PTM, 16), secondary tracheal malignant (STM, 38), benign tracheal neoplasia (BTN, 1); 21 patients in this group had tracheal patch grafts made of Marlex mesh and pericardium; six had a bifurcation resection. Group 2 consisted of non-neoplastic (27) sub-divided into: post-intubation injuries (PII, 24) and traumatic or congenital fistula of the trachea (CTL, 3); 23 patients in this group had circumferential, and the remaining four had partial circumferential, excision of the trachea followed by reconstruction. One patient in this group had tracheal patch graft. Hospital mortality/morbidity, relief of symptoms, recurrence of lesions and long-term survival are considered. RESULTS: Group 1: Five patients (9%) died in hospital; 12 patients, four (two with patch graft) in the PTM, seven (three with patch graft) in the STM group and one in the BTT group survived between 7 and 22 years, one patient is undergoing endoscopic laser. Group 2: There was one death 2 months after surgery. Two patients had recurrence of stricture, one requiring T tube stent, the other endoscopic laser therapy; 24 patients (one with patch graft) remain well between 7 and 22 years. CONCLUSION: Tracheal resection and reconstruction is attended by good functional results. The long-term outcome for malignant disease relates to the histology and tumour staging. Patch grafting using a composite prosthesis of Marlex mesh and pericardium has a chance of long-lasting success when used in selected patients.
OBJECTIVE: To assess early and long term (>5 years) results of tracheal resection and reconstruction. PATIENTS AND METHODS: Eighty-two patients amongst 144 with a variety of tracheal lesions, undergoing resection and reconstruction referred to a single surgeon. A retrospective study, the patients were grouped into: Group 1 neoplastic (n = 55) subdivided into: primary tracheal malignancy (PTM, 16), secondary tracheal malignant (STM, 38), benign tracheal neoplasia (BTN, 1); 21 patients in this group had tracheal patch grafts made of Marlex mesh and pericardium; six had a bifurcation resection. Group 2 consisted of non-neoplastic (27) sub-divided into: post-intubation injuries (PII, 24) and traumatic or congenital fistula of the trachea (CTL, 3); 23 patients in this group had circumferential, and the remaining four had partial circumferential, excision of the trachea followed by reconstruction. One patient in this group had tracheal patch graft. Hospital mortality/morbidity, relief of symptoms, recurrence of lesions and long-term survival are considered. RESULTS: Group 1: Five patients (9%) died in hospital; 12 patients, four (two with patch graft) in the PTM, seven (three with patch graft) in the STM group and one in the BTT group survived between 7 and 22 years, one patient is undergoing endoscopic laser. Group 2: There was one death 2 months after surgery. Two patients had recurrence of stricture, one requiring T tube stent, the other endoscopic laser therapy; 24 patients (one with patch graft) remain well between 7 and 22 years. CONCLUSION: Tracheal resection and reconstruction is attended by good functional results. The long-term outcome for malignant disease relates to the histology and tumour staging. Patch grafting using a composite prosthesis of Marlex mesh and pericardium has a chance of long-lasting success when used in selected patients.