Tracheal surgery.

In the last 20 years the techniques for resection of the trachea with primary reconstruction have evolved to a point where most lesions involving up to 50% of the trachea can be successfully and dependably managed. A notable exception is the lengthy infiltrating adenoidcystic carcinoma. Postintubation stenosis is largely correctible in an initial operative approach. The operation has such a high degree of success that it appears to be the treatment of choice. Primary tracheal tumors and selected secondary tracheal tumors are often amenable to surgical resection, with the addition of radiotherapy for certain histologic types. Results strongly support this aggressive approach. Three problems of current interest seem to be yielding to surgical correction although decisions about the time of surgery, the delicacy of surgical execution from the postoperative management all present difficult problems. These are the repair of the rare congenital tracheal stenosis in children, resection and reconstruction of the carina and correction of subglottic and upper tracheal stenosis.