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. 2024 Apr 12:10:1229522.
doi: 10.3389/fsurg.2023.1229522. eCollection 2023.

Sleeve resection with end-to-end anastomosis in the reconstruction of tracheal defects exceeding six rings: a clinical feasibility study and safety assessment

Xin Xia  1 , Xiaoli Zhu  1 , Yingying Zhu  1 , Wenwen Diao  1 , Xingming Chen  1
Affiliations

Sleeve resection with end-to-end anastomosis in the reconstruction of tracheal defects exceeding six rings: a clinical feasibility study and safety assessment

Xin Xia et al. Front Surg. .

Abstract

Objectives: Reconstruction is always required for tracheal defects and sleeve resection with end-to-end anastomosis is the most common used. The aim of the study was to present surgical techniques and evaluate the outcomes of sleeve resection with end-to-end anastomosis in the reconstruction of tracheal defects exceeding six rings.

Methods: The study included patients with primary or secondary malignancies and tracheal stenosis from 2014 to 2019, who were treated with sleeve resection exceeding six tracheal rings, and reconstructed with end-to-end anastomosis. Airway status and patient outcomes were the principal follow-up measures.

Results: A total of 16 patients were enrolled in the study including three primary tracheal malignancies, 12 invasive thyroid carcinomas and one with tracheal stenosis. The extent of tracheal resection ranged from seven to nine rings, and the primary end-to-end anastomosis was performed in all 16 patients. Performance of tracheostomy or cricothyroidotomy was done in 6 patients with decannulation at a median of 42 days (range, 28-56). No anastomotic dehiscence, infection or bleeding occurred postoperatively, and all 16 patients maintained an unobstructed airway through the end of follow-up.

Conclusions: Sleeve resection reconstructed with end-to-end anastomosis can serve as an appropriate therapeutic strategy for the tracheal defects even exceeding six rings. Adequate laryngeal release is the key to surgical success.

Keywords: end-to-end anastomosis; long-segment; sleeve resection; tracheal defect; tracheal reconstruction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) and (B) computed tomography showed a thyroid neoplasm with invasion of the trachea. (C) Fiberoptic laryngoscopy evaluation showed that the tumor invaded the left tracheal wall with obstruction of approximately one-half of the lumen. (D) The en-bloc resection specimen. The 1st–9th tracheal rings, anterolateral cricoid cartilage, cervical strap muscles and the hyoid bone were resected along with the thyroid carcinoma.
Figure 2
Figure 2
(A) Adequate release of the trachea and larynx. (B) The end-to-end anastomosis with continuous “2-0” polypropylene sutures. (C) Secure larynx-to-trachea anastomosis with minimal tension. (D) Fiberoptic laryngoscopy showed stability of the anastomosis and lumen 6 months postoperatively.
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