Tracheoplasty with free autopericardium in case of tumor stenosis

Relevance. Reconstructive plastic surgery on the trachea remains one of the most important and dramatic sections in thoracic surgery. Primary anastomosis is the gold standard in patients who require resection of any organ except for long sections of the trachea. End-to-end tracheal anastomosis can be relatively safely performed after resection of no more than half of the trachea in an adult. And even in expert-level clinics, such operations are accompanied by a high level of postoperative complications. Currently, this approach is used in the vast majority of cases of benign stenosis and in many cases of tumor damage to the respiratory tract. Reconstructive plastic surgery of the respiratory tract is one of the most difficult sections of modern medicine. This is due to the relatively small length of the trachea itself, the peculiarities of the blood supply, constant contact of the tracheal mucosa with atmospheric air and potentially dangerous infections. Therefore, the results of surgical treatment of extended and subtotal tracheal lesions of tumor and benign genesis remain unconsoling even at present.
Сlinical observation. A clinical observation of the treatment of a patient with tumor stenosis of the thoracic trachea is presented, after an unsuccessful attempt at tracheal stenting. Considering the presence of a widespread tumor lesion of the thoracic trachea, the presence of inflammatory changes in the walls as a result of stenting, high risks of anastomositis and failure, it was decided to refrain from performing a circular resection of the thoracic trachea in favor of a final resection of the thoracic trachea with autopericardial plasty. After completion of tracheoplasty, a control bronchoscopy was performed, which revealed a deformation of the thoracic trachea in the area of the eliminated defect, but without significant narrowing of the lumen. The result of the plastic surgery was considered satisfactory. A control bronchoscopy 6 months after the operation revealed a good lumen of the trachea along its entire length. The condition of the flap was assessed as satisfactory, its surface was completely cleared of fibrin, epithelialization of the autopericardium was observed. In this clinical case, an extensive tracheal defect (5.5×2.0 cm) was eliminated for the first time, occupying not only the membranous, but also the right lateral and partially the anterior cartilaginous walls of the thoracic trachea. Due to a number of circumstances, it was necessary to use an autopericardial flap without a feeding pedicle. The operation was performed for vital indications due to increasing stridor, without any time to prepare the patient according to tracheal surgery protocols.
Conclusion. This clinical observation indicates that in patients with extensive tumors of the thoracic trachea that are insensitive to drug treatment and radiation therapy, complicated by decompensated tumor stenosis of the airway, an alternative approach to treatment is possible, including final resection with tracheal plastic surgery using an autopericardium on a feeding pedicle.
Keywords: tumor stenosis of the trachea, circular resection of the trachea, anastomosis, stenting, tracheoplasty, tracheostomy, trachea, stenosis, stent, T-tube, continuous suture, tracheal schwannoma, autopericardial plastic surgery, restenosis
Conflict of interest. The authors declare that they have no conflict of interest.
Funding. This study required no funding