Reconstruction of the Trachea

Abstract

Thirty two patients requiring reconstruction of the trachea were treated at the Department of Thoracic Surgery of Chest Disease Research Institute of Kyoto University from 1972 through 1983. There were 10 primary tracheal tumors, of which five were adenoid cystic carcinomas, three were squamous cell carcinomas, one was giant cell carcinoma and one was plasmacytoma. Tumors with tracheal involvement included 15 thyroid carcinomas and three esophageal carcinomas. The remainder were four inflammations, of which two were tracheal tuberculosis and two were granulation after tracheostomy. In'eight of the primary tracheal tumors, direct anastomosis was performed. Fenestration was per-formed in two patients. The longest resection of the trachea in direct anastomosis cases was six cm, i.e. ten cartilage crescents. The resectable extent for direct anastomosis was influenced by age and preoperative irradiation. In cases of thyroid and esophageal carcinomas, primary end-to-end anastomosis could be performed in only four cases. In 14 cases, fenestration was performed because of difficulty of swallowing due to resection of the recurrent nerve. Postoperative complications, such as anastmosis dehiscence and perforation of large arteries were noted in six patients. All cases were irradiated before surgery. Preoperative irradiation was considered to be a large contraindication of tracheal surgery.