[Tracheal adenoid cystic carcinoma treated by complete carinal reconstruction with the help of an ECMO: about a case]

How thoracic surgeon manage tracheal tumors in African country? (Case series)

Introduction

Tracheal tumors are a rare pathological entity whose diagnosis is usually delayed by clinical latency. Surgery, which consists of a tracheal resection-anastomosis with or without reconstructive reconstruction, remains the treatment that ensures the best long-term survival.

Methods

This is a retrospective study about 8 patients admitted in the department of thoracic surgery of Hassan II's university hospital of Fes for tracheal tumors management during 7 years time (December 2010 to December 2017).

Results

There were 6 men and 2 women with an average age of 44.4 years ranged from 17 to 65 years, 4 were smokers. Dyspnea was the main trigger sign. Seven (7) have undergone bronchial fibroscopy diagnostic with a finding of budding process in 5 patients, the middle of the trachea is often concerned in 3 patients, obstructing the lumen of the trachea in almost all patients. The treatment in all patients was surgical with an intubation via the operative field, 4 trachea resection-anastomosis, 4 plasty (Lateral resection with V plasty, Kergin's plasty, Mattey's tracheobronchial anastomosis and widened V-resection to the carina). The most common histological type in our series was Adenoid Cystic Carcinoma in 2 of our patients. For the other patients we have found squamous cell carcinoma (1 case), adenocarcinoma (1 case), atypical carcinoid tumor (1 case), low grade mucoepidermoid carcinoma (1 case), an adenoma pleomorph (1 case) and endotracheal goiter (1 case). The operative follow-up was simple in 7 of our patients, all of whom underwent post-operative fibroscopy within an average of 9 days. Two cases of post-operative recurrent palsy had been observed, all of which had progressed well under treatment. We have noted 2 deaths, including one at day 4 post-operative, and the other died from complications of post-radiation tracheal stenosis. Back to 32 months' average follow-up, we have enregistered a case of a distant relapse by cervical lymph node metastasis in one patient, 5 years after surgery.

Conclusion

Primary tumors of the trachea remain of reserved prognosis with 5-year survival of 57% of all histological types combined. Computed tomodensitometry and tracheobronchial fibroscopy remain the means of reference exploration in the diagnosis and assessment of surgical resectability.

Resection of the Tracheobronchial Bifurcation With Complete Preservation of Lung Parenchyma

BACKGROUND

The resection of the tracheobronchial bifurcation with complete preservation of lung parenchyma remains a challenge owing to the limited indications for surgery, anesthesiologic management, operative technique, and postoperative course. The aim of this retrospective study was to evaluate factors influencing the perioperative course and long-term survival.

METHODS

Between 1989 and 2014, 19 patients underwent a resection of the distal trachea and carina with complete preservation of lung tissue, 16 for malignant tumors (7 adenoid cystic carcinomas, 3 carcinoid tumors, 3 mucoepidermoid tumors, 2 squamous cell carcinomas, and 1 small cell carcinomas), 2 for inflammatory stenosis, and 1 after a complex traumatic rupture.

RESULTS

Surgical approach was posterolateral thoracotomy in 17 patients and median sternotomy in 2. In 16 patients, end-to-end anastomosis was performed, and in 3 patients, combined end-to-end and side-to-end anastomosis were performed. The operative mortality was 0%, the perioperative complication rate was 26.3%. Six patients with adenoid cystic carcinoma and all patients with lung carcinoma received adjuvant radiotherapy; only 1 patient with small cell lung cancer had chemotherapy before surgery. Long-term results are excellent in patients with benign disease, typical and atypical carcinoid tumor, mucoepidermoid carcinoma, and in most patients with adenoid cystic carcinoma. Two patients with lung cancer died 28 and 45 months after surgery, and 1 patient with adenoid cystic carcinoma died 75 months after surgery.

CONCLUSIONS

Resection of the tracheobronchial bifurcation with complete preservation of lung indicated for selected patients with local tumor growth at the distal trachea and carina provides low perioperative mortality and complications and results in long-term survival rates.