Long‐term outcomes of microsurgical reconstruction for large tracheal defects

• Published in: Cancer 2011-02, Vol.117 (4), p.802-808
• Main Authors: Yu, Peirong, Clayman, Gary L., Walsh, Garrett L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; air leak; Biological and medical sciences; Endocrinopathies; Female; Humans; Keywords; Male; Malignant tumors; Medical sciences; Microsurgery; Middle Aged; Postoperative Care; Postoperative Complications; Prosthesis Implantation; radial forearm flap; Reconstructive Surgical Procedures; Surgical Flaps; thyroid cancer; Thyroid. Thyroid axis (diseases); Trachea - surgery; Tracheal Neoplasms - surgery; tracheal reconstruction; tracheal stent; tracheal tumor; Tracheostomy; Treatment Outcome; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.25492

BACKGROUND: Reconstruction of large tracheal defects has been largely unsuccessful. The purpose of this study was to review the authors' experience with microsurgical reconstruction of these defects. METHODS: Seven cases of microsurgical tracheal reconstruction were performed between May 2002 and April 2008. All but 1 patient had recurrent thyroid cancer; the other patient had primary adenocystic carcinoma of the trachea. The radial forearm free flap was used for lining in all cases. Rigid support was provided with a variety of prosthetic materials. RESULTS: All defects involved the cervical trachea, with an average length of 5.8 cm ± 1.0 cm (range, 5 cm‐7.5 cm). The width of defects ranged from half of the tracheal circumference to the entire circumference. Major complications included air leak in 4 patients, exposure and removal of prosthesis in 2 patients, and cardiopulmonary complications in 2 patients. One patient with postoperative retroperitoneal hematoma, abdominal compartment syndrome, and multiple organ failure died 2 months after surgery. Two patients died of other causes 1 year and 4 years, respectively, after surgery. The other 4 patients were alive and disease free, with follow‐up ranging from 1 to 4.5 years. Four patients are asymptomatic, with normal speech and swallowing functions. Two patients remained tracheostomy dependent, but vocal ability was intact. All patients tolerated a regular diet. CONCLUSIONS: Microsurgical reconstruction is a viable option in selected patients with large cervical tracheal defects that are beyond primary repair. Cancer 2011. © 2010 American Cancer Society. Microsurgical reconstruction of long tracheal defects with radial forearm free flap for lining and prosthetic material for rigid support may yield good outcomes in selected patients.