Surgical Management

Until the development of current techniques of tracheal resection and reconstruction, prospects for cure of tracheal tumors were small. Even when a lesion seemed potentially curable, some surgeons were often so inhibited by fear of inability to reconstruct the trachea that they settled for very limited local resection, often lateral resection, in an effort to maintain tracheal continuity. Local recurrence frequently followed such limited resection. Radiotherapy almost uniformly resulted in local recurrence even of radiosensitive tumors after varying periods of time, longer with ACC (3 to 7 years) than with squamous carcinoma (1 to 2/2 years). Characteristic reports from this era were those by Houston and colleagues in 1969, listing 53 primary tracheal cancers seen over a 30-year period, and by Hajdu and colleagues in 1970, noting 41 patients over a 33-year period.80,81 Because data is limited—due to the still relatively small number of cases reported, the absence of many single institutional series of significant size with prolonged follow-up, and the wide range in types and behavior of tracheal tumors—it is difficult to be categorical about management. However, enough information has accumulated in the past 30 years to formulate preliminary conclusions. In 1978, Grillo reported 63 patients, and in 1990, Grillo and Mathisen reported 198 patients with primary tracheal tumors treated at MGH, the latter report spanning 26 years.1,82 Eschapasse, Pearson, and Perelman, and their colleagues offered significant series.3,4,83 The combined experience of 26 French, German, and Italian hospitals was reported in 1996 by Regnard and colleagues.5

The distribution of primary tumors has been noted previously. In a 1990 series, 132 (66%) of our patients underwent resection with primary reconstruction of the airway (Table 7-6).1 In 9 of these (adenoid cystic 3, squamous 1, other 5), involvement of the lower larynx by a high tracheal tumor required removal of a portion of the larynx with suitable tailoring of the distal trachea to accomplish reanastomosis with a remaining functional larynx (see Chapter 25, "Laryngotracheal Reconstruction"). In an additional small

Table 7-6 Primary Tracheal Tumors (1990)

Variable

Squamous

Adenoid Cystic

Other

Total

Number of lesions

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