Tracheal Resection after Previous Treatment Provides Comparable Outcome to Primary Surgery

Background Tracheal and laryngotracheal surgery provides both excellent functional results and long-term outcomes in the treatment of tracheal stenosis. Consequently, challenging re-resections are rarely necessary. The purpose of this study was to compare the outcome of (laryngo-)tracheal re-resection and surgery after bronchoscopic interventions with that of primary surgery. Methods Patients undergoing resection for benign tracheal stenosis at our center between 1/2016 and 4/2020 were included. Perioperative characteristics and functional outcomes of patients were used for statistical analysis. Results Sixty-six patients who underwent (laryngo-)tracheal resection were included (previous resection [A=6], previous stent [B=6], previous bronchoscopic intervention w/o stenting [C=19], untreated [D=35]). Baseline parameters were largely comparable between groups with exception from group B that had significantly worse lung function. Group A necessitated more complex reconstructions (end-to-end: n =1: 17%| cricotracheal n =2: 33%| cricotracheal with mucosectomy n =2: 33%| laryngoplasty: n =1: 17%) than patients in group D (end-to-end n =21: 60%| cricotracheal n =14: 40%). Postoperative outcomes were comparable throughout groups (intensive care unit: 1[1-18] days; hospital stay: 8[5-71] days). Anastomotic complications were higher after previous stenting (A: 0%; B: 33.3%; C: 10.5%; D: 2.9%; B/D p =0.008| surgical revisions: A: 16.7%; B: 33.3%; C: 0%; D: 5.7%; B/D, p =0.035). Overall, postoperative lung function was significantly better (forced expiratory volume in 1 second: 63%24 vs. 75%+/- 20; p =0.001 | PeakEF 3.3 +/- 1.9 vs. 5.0 +/- 2.2L; p =0.001). No 90-day mortality was observed in any group. Median follow-up was 12(1-47) months. Conclusion In carefully selected patients treated in a specialized center, tracheal or laryngotracheal resection after previous tracheal interventions provides comparable outcome to primary surgery.

Automated summary

The study found that in carefully selected patients, tracheal or laryngotracheal resection after previous interventions provides comparable outcomes to primary surgery.