Primary tracheal tumors: treatment and results.

Grillo HC, Mathisen DJ.   Ann Thorac Surg. 1990 Jan;49(1):69-77.

General Thoracic Surgical Unit, Massachusetts General Hospital, Boston 02114.

One hundred ninety-eight patients with primary tracheal tumors were evaluated in 26 years. One hundred forty-seven tumors were excised (74%): 132 (66%) by resection and primary reconstruction, seven by laryngotracheal resection or cervicomediastinal exenteration, and eight by staged procedures. Eleven more were explored. Forty-four squamous cell carcinomas were resected, 60 adenoid cystic, and 43 assorted tumors, benign and malignant. Eighty-two patients underwent tracheal resection with primary reconstruction, and 50 had carinal resection and reconstruction. Surgical mortality for resection with primary reconstruction was 5%, with one death after tracheal and six after carinal repair. Six patients had stenosis after tracheal or carinal resection; all underwent reresection successfully. Nearly all patients with squamous or adenoid cystic carcinoma were irradiated postoperatively. Twenty of 41 survivors of resection of squamous cell carcinoma are living free of disease (some for more than 25 years), 39 of 52 with adenoid cystic carcinoma (up to nearly 19 years), and 35 of 42 with other lesions (5 lost to follow-up). Comparison of length of survival of patients with squamous cell carcinoma and adenoid cystic carcinoma who are alive without disease with those who died with carcinoma supports surgical treatment (usually followed by irradiation). Positive lymph nodes or invasive disease at resection margins appear to have an adverse effect on cure of squamous cell carcinoma; such an effect is not demonstrable with adenoid cystic carcinoma.

Management of tumors of the trachea.

Grillo HC, Mathisen DJ, Wain JC.   Oncology (Huntingt). 1992 Feb;6(2):61-7

General Thoracic Surgical Unit, Massachusetts General Hospital.

Experience in the management of primary tracheal tumors remains small because of their rarity. Adenoidcystic carcinoma (40%) and squamous cell carcinoma off%) are the most common histologies. They present with signs of airway obstruction or hemoptysis and are delineated by bronchoscopy, tomography, and CT scan. Two thirds of all tracheal tumors are resectable, followed by airway reconstruction. Postoperative irradiation appears to be indicated for malignant tumors. Surgical mortality in 147 resections was 5%, with most deaths following carinal reconstruction. Twenty of 41 patients with squamous cell carcinomas who underwent resection are alive without disease (some for more than 25 years) and 39 of 52 with adenoidcystic carcinoma (some for as long as 19 years).

Experience with primary neoplasms of the trachea and carina.

Pearson FG, Todd TR, Cooper JD.   J Thorac Cardiovasc Surg. 1984 Oct;88(4):511-8.

From 1963 to 1983, 44 patients presented with a primary tracheal neoplasm that was amenable to surgical treatment. Forty-two of the 44 tumors were malignant. Thirty-three patients were managed by resection and primary anastomosis. The following resections were done: trachea only, 12; trachea plus carina, 13; trachea plus cricoid cartilage, four; and trachea plus larynx, four. There were two operative deaths in these 33 patients. Prosthetic reconstruction with heavy-duty Marlex mesh was done in six patients. Three of the six died of erosion of the innominate artery during the postoperative period. In three patients with nonresectable tumors, a silicone-coated Montgomery T-tube provided transient but worthwhile palliation. In two patients with nonobstructive adenoid cystic carcinoma involving the subglottis, irradiation was chosen as the initial treatment, since resection would necessitate laryngectomy. Resection, including laryngectomy, may be required in the future. The following points are emphasized: (1) A majority of operable neoplasms can be resected through a cervical collar incision and median sternotomy. Median sternotomy is the optimal operative exposure in most neoplasms necessitating resection of the carina. (2) Partial resection of the cricoid with sparing of the recurrent laryngeal nerves and larynx is possible in some patients with primary malignant tumors involving the proximal trachea and subglottic region. (3) In patients with adenoid cystic carcinoma, resection may afford excellent, long-term palliation even when the resection is incomplete. Pulmonary metastases are common in patients with adenoid cystic tumors. However, they usually progress slowly, may remain asymptomatic for many years, and are not necessarily a contraindication to resection of the primary tumor even when they are synchronous. Our experience suggests that adjunctive radiotherapy is beneficial in patients with adenoid cystic carcinoma.

Surgical management of primary cervical tracheal cancer

Pan XL, Lei DP, Xu FL, Zhang LQ, Liu DY, Xie G, Luan XY.   Zhonghua Er Bi Yan Hou Ke Za Zhi. 2003 Dec;38(6):437-9.
Department of Otorhinolaryngolgy, Qilu Hospital of Shandong University, Jinan 250012, China.

OBJECTIVE: To review the experience of surgical treatment of primary cervical tracheal cancer. METHODS: Six patients with primary cervical tracheal cancer were treated surgically from January 1997 to April 1999. The trachea anastomosis, platysmamyocutaneous flap combiend with the facial flap of the sternohyoid muscle, sternocleidomastoid myoperiosteal flap and the pectoralis major muculocutaneous flap were applied to restore the defects of cervical trachea. By pathology, there were two squamous cell carcinomas, three adenoid cystic carcinomas, and one adenocarcinoma. RESULTS: Six cases were decannulated from 23 days to 3 months after operation. The length of follow-up was more than 3 years. Five cases have stable airway by fiberscope and good voice after decannulation and there is no recurrence. One case died of lung metastasis 2 years after operation. CONCLUSION: Trachea anastomosis is suited for small partial defect. The platysmamyocutaneous flap combined with the facial flap of the sternohyoid muscle, sternocleidomastoid myoperiosteal flap and the pectoralis major muculocutaneous flap are ideal transplant for cervical tracheal reconstruction.

Results and prognostic factors in resections of primary tracheal tumors: a multicenter retrospective study. The French Society of Cardiovascular Surgery.

Regnard JF, Fourquier P, Levasseur P.  J Thorac Cardiovasc Surg. 1996 Apr;111(4):808-13

Hopital Marie Lannelongue, Le Plessis-Robinson, France.

To determine long-term survival and prognostic factors, 208 patients with primary tracheal tumors were evaluated in a retrospective multicenter study including 26 centers. Ninety-four patients had squamous cell carcinoma, four had adenocarcinoma, 65 had adenoid cystic carcinoma, and 45 patients had miscellaneous tumors. The following resections were performed: tracheal resection with primary anastomosis, 165; carinal resection, 24; and laryngotracheal resection, 19. Postoperative mortality rate was 10.5% and correlated with the length of the resection, the need for a laryngeal release, the type of resection, and the histologic type of the cancer. Fifty-nine percent of patients with tracheal cancer and 43% of patients with adenoid cystic carcinomas had postoperative radiotherapy. The 5- and 10-year survivals, respectively, were 73% and 57% for adenoid cystic carcinomas and 47% and 36% for tracheal cancers (p < 0.05). Among patients with tracheal cancers, survival was significantly longer for those with complete resections than for those with incomplete resections. On the other hand, the presence of positive lymph nodes did not seem to decrease survival. Postoperative radiotherapy increased survival only in the case of incompletely resected tracheal cancers. Long-term prognosis was worsened by the occurrence of second primary malignancies in patients with tracheal cancers and by the occurrence of late pulmonary metastases in patients with adenoid cystic carcinomas.