Treatment of laryngotracheal and tracheal cicatricial stenosis: 10-year experience

Topolnitskiy E.B.; Shefer N.A.; Podgornov V.F.

doi:https://doi.org/10.17116/hirurgia202203136

Topolnitskiy E.B.

Siberian State Medical University;
Tomsk Regional Clinical Hospital;
National Research Tomsk State University

SPIN RSCI: 6744-9541
Scopus AuthorID: 35197267200
ResearcherID: T-5818-2018
ORCID: 0000-0002-5674-0177

Shefer N.A.

Tomsk Regional Oncology Dispensary

SPIN RSCI: 3662-7399
Scopus AuthorID: 57211683932
ResearcherID: HJY-1484-2023
ORCID: 0000-0002-0011-8370

Podgornov V.F.

Tomsk Regional Clinical Hospital;
Alperovich Clinical Hospital No. 3

Treatment of laryngotracheal and tracheal cicatricial stenosis: 10-year experience

Authors:

Topolnitskiy E.B., Shefer N.A., Podgornov V.F.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2022;(3): 36‑43

DOI: 10.17116/hirurgia202203136

Read: 2752 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Topolnitskiy EB, Shefer NA, Podgornov VF. Treatment of laryngotracheal and tracheal cicatricial stenosis: 10-year experience. Pirogov Russian Journal of Surgery. 2022;(3):36‑43. (In Russ.)
https://doi.org/10.17116/hirurgia202203136

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To describe 10-year experience of treating the cicatricial tracheal stenosis (CTS) in a regional multi-field hospital.

MATERIAL AND METHODS

There were 120 CTS patients aged 13—75 years. In 8 (6.7%) patients, CTS was combined with tracheoesophageal fistula (TPF). Post-intubation stenosis was diagnosed in 16 (13.3%) cases, post-tracheostomy — in 102 (85%) ones, post-traumatic — in 2 (1.7%) patients. CTS length ranged from 1.2 to 8 cm. Fifty (41.7%) patients had cervical CTS, 40 (33.3%) patients — cervico-thoracic tracheal stenosis, 11 (9.2%) patients — tracheal stenosis at the thoracic level. Nineteen (15.8%) patients had multifocal stenoses. We used endoscopic techniques, circular tracheal resection (CTR) and laryngotracheal reconstruction.

RESULTS

Postoperative mortality rate was 0.83%. CTR was performed in 33 patients, laryngotracheal reconstruction — 77, endoscopic stenting — 6 patients. In 4 cases, local CTS was eliminated by bougienage and argon plasma exposure. CTS was successfully disconnected with TEF using CRT in 3 cases, laryngotracheoplasty and stenting — in 5 cases. The fenestrated tracheal defect was closed by a three-layer autologous flap in 59 patients. Of these, autologous flap was reinforced with porous nickel-titanium implants in 17 patients. Postoperative complications after CRT occurred in 6 (16.7%) patients (anastomotic leakage — 2, anastomositis — 1, restenosis — 2). No patients died. Postoperative complications after laryngotracheal reconstruction were observed in 18 (23.4%) patients including 5 ones with restenosis who underwent CTR with a favorable outcome.

CONCLUSION

CTS treatment requires a multidisciplinary approach. Each surgery has certain indications and place in treatment algorithm. CTR is highly effective, but may be accompanied by complications associated with tracheal anastomosis. Decrease of postoperative morbidity will improve immediate and long-term results of CTS treatment. The chosen treatment algorithm ensured good and satisfactory results in 98% of patients.

Keywords:

cicatricial tracheal stenosis

tracheoesophageal fistula

tracheal resection

laryngotracheal reconstruction

tracheal stenting

Authors:

Topolnitskiy E.B.

Siberian State Medical University;
Tomsk Regional Clinical Hospital;
National Research Tomsk State University

SPIN RSCI: 6744-9541
Scopus AuthorID: 35197267200
ResearcherID: T-5818-2018
ORCID: 0000-0002-5674-0177

Shefer N.A.

Tomsk Regional Oncology Dispensary

SPIN RSCI: 3662-7399
Scopus AuthorID: 57211683932
ResearcherID: HJY-1484-2023
ORCID: 0000-0002-0011-8370

Podgornov V.F.

Tomsk Regional Clinical Hospital;
Alperovich Clinical Hospital No. 3

Received:

25.08.2021

Accepted:

21.09.2021

Close metadata

References:

Kurgansky IS, Makhutov VN, Lepekhova SA. The methods for the treatment and prevention of cicatricalstenoses of tracheal. Vestnik otorinolaringologii. 2016;1:66-71. (In Russ.). https://doi.org/10.17116/otorino201681166-71
Mosin IV, Sanginov AB, Bazhanov AA. Treatment of the extensive cicatricial stenoses of the upper third of trachea. Khirurgiya. Zhurnal im. N.I. Pirogova. 2011;2:37-39. (In Russ.).
Li M, Yiu Y, Merrill T, Yildiz V, deSilva B, Matrka L. Risk Factors for Posttracheostomy Tracheal Stenosis. Otolaryngol Head Neck Surg. 2018;159(4):698-704. https://doi.org/10.1177/0194599818794456
Rea F, Callegaro D, Loy M, Zuin A, Narne S, Gobbi T, Grapeggia M, Sartori F. Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg. 2002;22(3):352-356. https://doi.org/10.1016/s1010-7940(02)00342-1
Vavin VV, Kuznetsova DA, Nazhmudinov II, Davudov KhSh. Etiopathogenetic factors of wound healing in chronic post-intubation cicatricial stenosis of the larynx and trachea. Vestnik otorinolaringologii. 2020;85(2):78-83. (In Russ.). https://doi.org/10.17116/otorino20208502178
Starostin AV, Berikkhanov ZG, Parshin AV, Amangeldiev DM. Etiology, diagnosis and treatment of cicatricial tracheal stenosis. Khirurgiya. Zhurnal im. N.I. Pirogova. 2020;4:53-60. (In Russ.). https://doi.org/10.17116/hirurgia202004153
D’Andrilli A, Venuta F, Rendina EA. Subglottic tracheal stenosis. J Thorac Dis. 2016;8(2):140-147. https://doi.org/10.3978/j.issn.2072-1439.2016.02.03
Siciliani A, Redino EA, Ibrahim M. State of the art in tracheal surgery: a brief literature review. Multidisciplinary Respiratory Medicine. 2018;13:34. https://doi.org/10.1186/s40248-018-0147-2
Yasnogorodsky OO, Shulutko AM, Pinchuk TP, Taldykin MV, Kachikin AS, Katanae YuA, Moiseev AYu, Guryanova YuV, Nasirov FN. Surgical and combined correction of tracheal and laryngotracheal cicatricial stenosis and restenosis Khirurgiya. Zurnal im. N.I. Pirogova. 2016;12:31-36. (In Russ.). https://doi.org/10.17116/hirurgia20161231-36
D’Andrilli A, Maurizi G, Andreetti C, Ciccone AM, Ibrahim M, Poggi C, Venuta F, Rendina EA. Long-term results of laryngotracheal resection for benign stenosis from a series of 109 consecutive patients. Eur J Cardiothorac Surg. 2016;50:105-109. https://doi.org/10.1093/ejcts/ezv471
Parshin VD, Rusakov MA, Parshin VV, Titov VA, Parshin AV, Starostin AV. Tracheolaryngeal resection for cicatricle stenosis. Khirurgiya. Zhurnal im. NI Pirogova. 2018;6:41-48. (In Russ.). https://doi.org/10.17116/hirurgia2018641-48
Wright CD, Grillo HC, Wain JC, Wong DR, Donahue DM, Gaissert HA, Mathisen DJ. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg. 2004;128(5):731-739. https://doi.org/10.1016/j.jtcvs.2004.07.005
Yagudin RK, Yagudin KF. The experience with the use of the two-step laryngotracheoplasty for the management of subglottic and combined subglottic and upper tracheal cicatrical stenosis in the adult patients. Vestnik otorinolaringologii. 2015;80(2):53-59. (In Russ.). https://doi.org/10.17116/otorino201580253-59
Parshin VD, Rusakov MA, Parshin VV, Amangeldiev DM, Parshin AV, Mayer RYu. Tracheal resection after prolonged stenting in surgery for cicatricial stenosis. Khirurgiya. Zhurnal im. N.I. Pirogova. 2019;11:5-12. (In Russ.). https://doi.org/10.17116/hirurgia20191115
Freitag L, Darwiche K. Endoscopic treatment of tracheal stenosis. Thorac Surg Clin. 2014;24(1):27-40. https://doi.org/10.1016/j.thorsurg.2013.10.003
Drobyazgin EA, Chikinev YuV, Anikina MS, Sudovykh IE. Endoscopic treatment of cicatrical tracheal stenoses. Grekov’s Bulletin of Surgery. 2019;178(5):10-15. (In Russ.). https://doi.org/10.24884/0042-4625-2019-178-5-10-15
Parshin VD, Porkhanov VA. Khirurgiya trakhei s atlasom operativnoj khirurgii. M.: Aldi-print; 2010. (In Russ.).
Stoelben E, Aleksanyan A. Technique of laryngotracheal resection in subglottic stenosis. J Thorac Dis. 2020;12(10):6152-6162. https://doi.org/10.21037/jtd.2020.04.06
Topolnitskiy EB, Dambaev GTs. The application of the cryosurgical and lymphotropic technologies for the combined treatment of postintubation thracheal stenosis. Vestnik otorinolaringologii. 2012;1:31-33. (In Russ.).
Hoetzenecker K, Schweiger T, Roesner I, Leonhard M, Marta G, Denk-Linnert DM, Schneider-Stickler B, Bigenzahn W, Klepetko W. A modified technique of laryngotracheal reconstruction without the need for prolonged postoperative stenting. J Thorac Cardiovasc Surg. 2016;152(4):1008-1017. https://doi.org/10.1016/j.jtcvs.2016.01.061
Parshin VD, Titov VA, Parshin VV, Parshin AV, Berikkhanov Z, Amangeldiev DM. Circular tracheal resection for cicatrical stenosis and functioning tracheostomy. Khirurgiya. Zhurnal im. N.I. Pirogova. 2017;9:23-32. (In Russ.). https://doi.org/10.17116/hirurgia2017923-32
Grillo H. Surgery of the trachea and bronchi. London: BC Decker Inc Hamilton; 2004.
Monnier P. Subglottic and Tracheal Stenosis. In: Remacle M, Eckel H, eds. Surgery of Larynx and Trachea. Springer, Berlin, Heidelberg; 2010. https://doi.org/10.1007/978-3-540-79136-2_12
Porkhanov VA, Zhikharev VA, Kononenko VB, Danilov VV, Naryzhny NV, Polyakov IS. Anesthetic management of reconstructive surgery on the respiratory tract. Khirurgiya. Zhurnal im. N.I. Pirogova. 2016;1:4-9. (In Russ.). https://doi.org/10.17116/hirurgia2016124-9
Schweiger T, de Faria Soares Rodrigues I, Roesner I, Schneider-Stickler B, Evermann M, Denk-Linnert DM, Hager H, Klepetko W, Hoetzenecker K. Laryngeal Mask as the Primary Airway Device During Laryngotracheal Surgery: Data from 108 patients. Ann Thorac Surg. 2020;110(1):251-257. https://doi.org/10.1016/j.athoracsur.2019.11.064
Piazza C, Filauro M, Dikkers FG, Reza Nouraei SA, Sandu K, Sittel C, Amin MR, Campos G, Eckel HE, Peretti G. Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society. Eur Arch Otorhinolaryngol. 2021;278:1-7. https://doi.org/10.1007/s00405-020-06112-6
Parshin AV, Chernousov AF, Parshin VD, Shepetovskaya NL, Parshin VV, Antonov VV. Long-term postoperative outcomes in patients with cicatricial tracheal stenosis depending on surgical approach. Khirurgiya. Zhurnal im. N.I. Pirogova. 2021;1:5-14. (In Russ.). https://doi.org/10.17116/hirurgia20210115
Ciccone AM, Vanni C, Maurizi G, D’Andrilli A, Korasidis S, Ibrahim M, Andreetti C, Venuta F, Rendina EA. A Novel Technique for Laryngotracheal Reconstruction for Idiopathic Subglottic Stenosis. Ann Thorac Surg. 2016;102(5):469-471. https://doi.org/10.1016/j.athoracsur.2016.03.098
Mohsen T, Abou Zeid A, Abdelfattah I, Mosleh M, Adel W, Helal A. Outcome after long-segment tracheal resection: study of 52 cases. Eur J Cardiothorac Surg. 2018;53:1186-1191. https://doi.org/10.1093/ejcts/ezx475
Parshin VD, Volkov AA, Parshin VV, Vishnevskaya GA. Tracheoplasty after circular trachea resection. Khirurgiya. Zhurnal im. N.I. Pirogova. 2011;12:4-9. (In Russ.).