Secondary neoplastic invasion of the trachea by direct extension is most often due to carcinomas of the esophagus, thyroid, and lung. Carcinoma of the larynx may also invade the trachea directly or it may recur at the margin of the stoma from lymphatics after laryngectomy. Less commonly, hematogenous metastases involve the trachea or carina. Sites of origin include the breast, melanoma, kidney, and thyroid. Carcinoma metastatic to the mucosa of the trachea from distant primary sites is less common than metastases to the bronchial mucosa, which is in itself an uncommon phenomenon.
The goals of major resection of the trachea or carina for secondary neoplasms should be the possibility of cure, or otherwise, prolonged palliation. This excludes most hematogenous metastases. Palliation of irresectable obstructing tumor may be achieved by endobronchial curettage, laser therapy, external beam irradiation, brachytherapy, or sometimes by stenting. The limited place for tracheal resection and reconstruction, when the airway is invaded by adjacent neoplasm, is considered below. The two most appropriate categories for surgical treatment are thyroid and bronchogenic carcinomas. Invasion by esophageal carcinoma is almost never an indication for tracheal resection.
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