Tracheobronchial resection and reconstruction

Objective: To assess the indications and results of airway resection and how frequently airway reconstructive options changed proposed therapy. Design: A retrospective survey of patients undergoing major airway resection. Setting: University of Washington-affiliated hospitals, Seattle, May 1992 through December 1996. Patients: Fifty consecutive patients with resectable benign and malignant tracheal or main bronchial disease undergoing tracheobronchial resections. Interventions: Patients underwent major airway resection as follows: tracheal or laryngotracheal resection, 23 patients; carinal resection, 6; and bronchial sleeve resection with or without pulmonary resection, 21. Indications for surgery were non-small cell lung cancer in 19 patients, primary airway tumor in 12, thyroid carcinoma in 1, and tracheal or bronchial stenosis in 18. Main Outcome Measures: Change in prereferral planned therapy from palliative to definitive or to pup monary- sparing procedure, morbidity and mortality, relief of symptoms, and survival. Results: Mortality was 0%, and morbidity, 32% (16/50). Airway reconstruction changed the proposed therapy in 42 patients (84%). Functional results were good to excellent in 17 (94%) of 18 patients with benign disease. Patients with malignant disease had a 1-year survival of 93% (27/29) and a 2-year survival of 67% (12/18). Conclusions: Airway resection and reconstruction provide reliable relief of benign and malignant tracheobronchial disease with minimal morbidity and mortality. Airway reconstruction frequently changed prereferral planned therapy and provided definitive and parenchymal-sparing procedures to patients with complex airway lesions.