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; Xiaoli Zhu; Yingying Zhu; Wenwen Diao; Xingming Chen

doi:10.3389/fsurg.2023.1229522

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

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

Authors

Xin Xia¹, Xiaoli Zhu¹, Yingying Zhu¹, Wenwen Diao¹, Xingming Chen¹

Affiliation

¹ Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

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.

Grants and funding

This study was supported by Science & Technology Fundamental Resources Investigation Program (2022FY100800), CAMS Innovation Fund for Medical Sciences (CIFMS) (2023-I2M-C&T-B-005, 2021-I2M-1-023 and 2020-I2M-2-009), and National High Level Hospital Clinical Research Funding (2022-PUMCH-B-094).