A 90-year-old woman with trachea-invading thyroid cancer requiring four-ring resection of cervical trachea because of airway stenosis.

The patient was a 90-year-old woman with chief complaints of hemoptysis and wheezing. Cervical computed tomography (CT) scans revealed a mass (2.5x2.0 cm) in the right lobe of the thyroid. The mass was exposed into the tracheal lumen, causing marked stenosis of the airway. When examined by bronchoscopy, the maximal degree of airway stenosis was about 75% of the tracheal cross section. During surgery, a resection of the right lobe of the thyroid was combined with a resection of the second to fifth cartilage ring of the cervical trachea for the purpose of complete resection of the thyroid cancer. During the same operation, the trachea was reconstructed by end-to-end anastomosis. For 1 week after surgery, a Mini-Trach II tube was left inserted to aspirate sputum, and the neck was kept bent forward (in the position of flexion). When sleeve resection of the trachea and subsequent end-to-end anastomosis are being performed, it is essential to manipulate the trachea in a protective manner, to preserve the nourishing vessels, to perform operative manipulation aseptically, to appropriately move the trachea, and to ensure reliable suturing with the goal of minimizing the incidence of complications such as anastomotic failure and stenosis of the anastomosed area. Although the patient was in advanced old age, her postoperative course was uneventful.