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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 511-518, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
FG Pearson, TR Todd and JD Cooper
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.
ARTICLES
Experience with primary neoplasms of the trachea and carina
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