Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach

Ann Thorac Cardiovasc Surg. 2018 Dec 20;24(6):288-295. doi: 10.5761/atcs.oa.18-00073. Epub 2018 Jun 7.

Abstract

Purpose: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis.

Methods: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis.

Results: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients.

Conclusion: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.

Keywords: bronchoscopy; post-intubation tracheal stenosis; tracheal resection.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Algorithms
  • Bronchoscopy* / adverse effects
  • Bronchoscopy* / instrumentation
  • Clinical Decision-Making
  • Cooperative Behavior
  • Decision Support Techniques
  • Female
  • Humans
  • Interdisciplinary Communication
  • Intubation, Intratracheal / adverse effects*
  • Male
  • Middle Aged
  • Patient Care Team*
  • Recurrence
  • Retrospective Studies
  • Severity of Illness Index
  • Stents
  • Thoracic Surgical Procedures* / adverse effects
  • Tracheal Stenosis / diagnostic imaging
  • Tracheal Stenosis / etiology
  • Tracheal Stenosis / surgery*
  • Tracheostomy / adverse effects*
  • Treatment Outcome
  • Young Adult