How thoracic surgeon manage tracheal tumors in African country? (Case series)

Abstract

Introduction: Tracheal tumors are a rare pathological entity whose diagnosis is usually delayed by clinical latency. Surgery, which consists of a tracheal resection-anastomosis with or without reconstructive reconstruction, remains the treatment that ensures the best long-term survival.

Methods: This is a retrospective study about 8 patients admitted in the department of thoracic surgery of Hassan II's university hospital of Fes for tracheal tumors management during 7 years time (December 2010 to December 2017).

Results: There were 6 men and 2 women with an average age of 44.4 years ranged from 17 to 65 years, 4 were smokers. Dyspnea was the main trigger sign. Seven (7) have undergone bronchial fibroscopy diagnostic with a finding of budding process in 5 patients, the middle of the trachea is often concerned in 3 patients, obstructing the lumen of the trachea in almost all patients. The treatment in all patients was surgical with an intubation via the operative field, 4 trachea resection-anastomosis, 4 plasty (Lateral resection with V plasty, Kergin's plasty, Mattey's tracheobronchial anastomosis and widened V-resection to the carina). The most common histological type in our series was Adenoid Cystic Carcinoma in 2 of our patients. For the other patients we have found squamous cell carcinoma (1 case), adenocarcinoma (1 case), atypical carcinoid tumor (1 case), low grade mucoepidermoid carcinoma (1 case), an adenoma pleomorph (1 case) and endotracheal goiter (1 case). The operative follow-up was simple in 7 of our patients, all of whom underwent post-operative fibroscopy within an average of 9 days. Two cases of post-operative recurrent palsy had been observed, all of which had progressed well under treatment. We have noted 2 deaths, including one at day 4 post-operative, and the other died from complications of post-radiation tracheal stenosis. Back to 32 months' average follow-up, we have enregistered a case of a distant relapse by cervical lymph node metastasis in one patient, 5 years after surgery.

Conclusion: Primary tumors of the trachea remain of reserved prognosis with 5-year survival of 57% of all histological types combined. Computed tomodensitometry and tracheobronchial fibroscopy remain the means of reference exploration in the diagnosis and assessment of surgical resectability.

Keywords: Adenoid cystic carcinoma; Rigid bronchoscopy; Surgery; Tracheal endoprosthesis; Tracheal stenosis; Tracheal tumors.

Fig. 1

Thoracic CT scan with sections showing endotracheal tumor.

Fig. 2

Thoracic CT scan frontal section showing tumor involving the tracheobronchial area.

Fig. 3

Endoscopic features of tracheal tumors (A: left laterotracheal tumor presenting as a smooth exophytic mass causing tracheal obstruction of 80%. B: Exophytic left tracheal wall mass with almost complete obstruction. C: Tracheal submucosal tumor.

Fig. 4

Some intubation procedures (A: surgical perioperative view showing lower tracheal part intubation through the operating field. B: surgical perioperative view showing right main bronchus intubation through the operating field.

Fig. 5

Stages of double barrel type tracheobronchial anastomosis (A: carina exposition through supracardiac vessels. B: anastomosis between the trachea and the 2 main bronchi after the tumor resection with the endotracheal tube in place. C: the end of the procedure showing carina reconstruction by Mattey technique).

Fig. 6

Postoperative endoscopic view showing the healing of the tracheal anastomosis.

Diagram 1

The technique of tracheal resection with end-to-end anastomosis.

Diagram 2

The technique of tracheal lateral resection with plastic reconstruction in ‘‘V’‘.

Diagram 3

Kergin technique with pneumectomy associated with tracheal plasty reconstruction.

Diagram 4

Carinal resection with plasty reconstruction in ‘‘V’.

Diagram 5

Carina reconstruction by Mattey technique.