Resection and reconstruction via median sternotomy incision for tracheal tumors

Abstract

Background: The tracheal tumor is a rare disease with low incidence in the upper airway. Surgical resection and reconstruction are effective and radical treatments for such conditions, but the approaches vary depending on the tumor location. The current report tends to illustrate the clinical practice and advantage of the median sternotomy approach for treating tracheal tumors.

Methods: We summarized and demonstrated four cases of tracheal tumors patients who received tracheal resection and reconstruction via median sternotomy approach in our institute. Their clinical data and surgical procedures were also described. The follow-up would be carried on to monitor their prognosis after the operations.

Results: Two patients with lower tracheal tumors involving carina received sternotomies, one with the tumor in cervical, thoracic junction, and the other one with thyroid carcinoma involving and extending to the thoracic trachea received half-sternotomies. The surgical procedures were completed smoothly with ideal surgical vision and sufficient operative space. Case 1 and 2 patients underwent tracheal-bronchial end-to-side anastomosis, while the other two patients received end-to-end anastomosis. The thymus and mediastinal tissue were used as the anastomotic buttress. They were discharged no more than 2 weeks after operations. Case 4 was suffered from aspiratory pneumonia and experienced prolonged intensive care unit (ICU) stay and antibiotic use. No other severe complications were recorded in other cases. No anastomotic dehiscence was observed in the postoperative bronchoscopy.

Conclusions: Tracheal resection and reconstruction via sternotomy or half-sternotomy is a practical approach for intrathoracic tracheal lesions. It facilitates a satisfying field and anastomosis procedure. The reported cases had ideal surgical outcomes. Although it is convenient in some specific cases, further studies are warranted for its safety and efficacy.

Keywords: Sternotomy; anastomosis; case series; surgery; tracheal tumor.

Figure 1

The pre-operative CT scan images of the patients. (A) The coronal and transverse section images of Case 1 showed an irregular mass located in the lower trachea involving the right lateral and posterior tracheal wall (red arrow: tracheal tumor). (B) The coronal and transverse section images of Case 2 showed a tumor involved lower trachea and LMB occluding most of the bronchial lumen (red arrow: tracheal tumor). (C) The coronal and transverse section images of Case 3 showed a tumor located in the junction of cervical and thoracic trachea involving the right lateral wall (red arrow: tracheal tumor). (D) The coronal and transverse section images of Case 4 showed a huge thyroid carcinoma with irregular shape and multiple calcifications invading into the trachea occluding most of the lumen (red arrow: tracheal tumor; yellow arrow: thyroid carcinoma). CT, computed tomography; LMB, left main bronchus.

Figure 2

The anatomic structures of trachea and peritracheal organs in median sternotomy approach. T, trachea; RMB, right main bronchus; LMB, left main bronchus; SVC, superior vena cava; RPA, right pulmonary artery; AA, ascending aorta.