Primary major airway tumors; management and results

• Published in: European journal of cardio-thoracic surgery 2011-05, Vol.39 (5), p.749-754
• Main Authors: Shadmehr, Mohammad Behgam, Farzanegan, Roya, Graili, Pooye, Javaherzadeh, Mojtaba, Arab, Mehrdad, Pejhan, Saviz, Karam, Mehrdad Bakhshayesh, Abbasidezfouli, Azizollah
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bronchoscopy; Carcinoid Tumor - diagnostic imaging; Carcinoid Tumor - pathology; Carcinoid Tumor - surgery; Carcinoma, Adenoid Cystic - diagnostic imaging; Carcinoma, Adenoid Cystic - pathology; Carcinoma, Adenoid Cystic - surgery; Cardiology. Vascular system; Child; Child, Preschool; Epidemiologic Methods; Female; Humans; Infant; Male; Medical sciences; Middle Aged; Pneumology; Pneumonectomy; Respiratory Tract Neoplasms - diagnostic imaging; Respiratory Tract Neoplasms - pathology; Respiratory Tract Neoplasms - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tomography, X-Ray Computed; Tracheostomy; Treatment Outcome; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2010.08.047

Objective: Primary major airway tumors are rare. A retrospective analysis of referral centers experience could be helpful for their management. Methods: Fifty-one patients, including 44 (86%) malignant and seven (14%) benign with primary tumors of subglottis, trachea, carina, and main stem bronchi, were managed in a 14-year period. Based on computed tomography (CT) scan and rigid bronchoscopy findings, those who evaluated as resectable underwent airway resection and reconstruction. The others were managed by one or a combination of these methods: core out, laser, chemotherapy, radiotherapy, and tracheostomy. Follow-up was completed in 88.2%, mean (35.2 ± 33.2 months). Results: Extraluminal extension of the tumor found in CT scan was significantly associated with unresectability (p = 0.006). Thirty-two patients underwent resection with three complications (9%) and one mortality (3%). Nineteen were managed by non-resectional methods; of these, 15 were found unresectable, because of tumor length, extensive local invasion or diffuse distant metastases, and four due to risk-benefit ratio or patient preference. Among 18 patients with adenoid cystic carcinoma 13 (72%) were resected (seven with negative margins). Overall 1-, 2-, 5-, and 8-year survival was 90.9%, 90.9%, 77.9%, and 19.5%, respectively. In unresectable tumors with adenoid cystic carcinoma, overall 1- and 2-year survival was 60% and 40%, respectively. Data analysis found significant association of long-term survival with resection (p = 0.005) but not with negative margins in adenoid cystic carcinoma. Among 15 patients with carcinoid tumors, all were alive at the end of follow-up, except one who died after surgery. Conclusions: Airway resection, if feasible, may extend survival and may even be curative, with low morbidity and mortality, in most patients with major airway tumors.