End-to-side anastomosis in complex tracheal resection and reconstruction: a case series study

Jiaxi He; Xin Xu; Lan Lan; Hanzhang Chen; Jianxing He; Shuben Li

doi:10.21037/tlcr-22-32

End-to-side anastomosis in complex tracheal resection and reconstruction: a case series study

Transl Lung Cancer Res. 2022 Feb;11(2):165-172. doi: 10.21037/tlcr-22-32.

Authors

Jiaxi He^#^{1

2}, Xin Xu^#^{1

2}, Lan Lan^#^{2

3}, Hanzhang Chen^{1

2}, Jianxing He^{1

2}, Shuben Li^{1

2}

Affiliations

¹ Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China.
³ Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

^# Contributed equally.

Abstract

Background: The development of current anesthetic and surgical techniques has increased the success rate of complex tracheal resection and reconstruction. End-to-end anastomosis is the prevailing method, while the end-to-side approach has also been reported to be practical and suitable. The current study aimed to demonstrate the feasibility and advantages of the end-to-side anastomosis method in specific cases.

Methods: We summarized 6 cases of patients with tracheobronchial tumors who received different end-to-side airway reconstructions in our center. Their clinical features and surgical procedures were also described. Postoperative follow-up was conducted to monitor their complications and prognosis.

Results: Among the patients involved in the study, 2 patients with tumors involving the bronchus intermedius received auto-lung transplantations under general anesthesia, 3 patients with tumors involving the lower trachea and carina underwent reconstruction under non-intubated combined anesthesia, and 1 patient with left main bronchus (LMB) involvement received surgery under venoarterial extracorporeal membrane oxygenation (VA ECMO)-supported non-intubated anesthesia. The surgical procedures were completed successfully without surgical or anesthetic incidents. Patients 1 and 2 underwent auto-lung transplantation with distal stumps and trachea end-to-side anastomosis (right lower lobe and right basal segment). Patients 3 and 4 received right main bronchus (RMB) to lateral trachea reconstruction, while Patients 5 and 6 underwent LMB to tracheal wall anastomosis. Anastomotic buttressing was performed using the thymus and mediastinal tissue. The patients were discharged within 2 weeks of the operation. No severe postoperative complications were reported, with the exception of Patient 5, who required a prolonged intensive care unit (ICU) stay with antibiotics due to pneumonia. Anastomotic necrosis, dehiscence, or stenosis were not observed in the postoperative bronchoscopy.

Conclusions: End-to-side anastomosis is a feasible and effective surgical method in airway reconstructions. This method facilitates tension-free anastomosis, which is crucial for surgical prognosis and decreasing complications. The reported cases had ideal surgical results during follow-up. The long-term outcomes of the end-to-side method require further evaluation.

Keywords: Trachea; anastomosis; case series; end-to-side; reconstruction.