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Henning A. Gaissert
Hermes C. Grillo
Cameron D. Wright
John C. Wain
Douglas J. Mathisen
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J Thorac Cardiovasc Surg 2005;129:1006-1009
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Laryngotracheoplastic resection for primary tumors of the proximal airway

Henning A. Gaissert, MDa,b,*, Hermes C. Grillo, MDa, Behgam M. Shadmehr, MDa, Cameron D. Wright, MDa, Manjusha Gokhale, MAc, John C. Wain, MDa, Douglas J. Mathisen, MDa

a Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
b Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
c Policy Analysis, Inc, Brookline, Mass.

Received for publication May 4, 2004; revisions received July 6, 2004; accepted for publication July 13, 2004.

* Address for reprints: Henning A. Gaissert, MD, Massachusetts General Hospital, Blake 1570, Fruit Street, Boston, MA 02114 (E-mail: hgaissert{at}partners.org).

BACKGROUND: Primary tumors of the airway with proximity to vocal cords and recurrent laryngeal nerves can be resected with sparing of the larynx. Long-term data on survival and local recurrence after laryngotracheal resection are scarce.

METHODS: We conducted a retrospective study of laryngotracheal resection and reconstruction for primary tumors of the airway since 1972.

RESULTS: Twenty-five patients aged 15 to 77 years presented with adenoid cystic carcinomas (n = 9), squamous cell carcinomas (n = 6), and other airway tumors (n = 10). Subglottic resection consisted of anterior cricoid in 5 patients; posterior cricoid mucosa in 9 patients, with resection of the posterior cricoid plate in 3 patients; lateral resection in 7 patients; and combined anterior and posterior elements in 4 patients. Vascularized trachea was tailored to reconstruct the defect. Seven patients without hoarseness required resection of the recurrent laryngeal nerve, and 4 other patients with hoarseness did not. There were no operative deaths. Two (8.0%) patients who had received prior high-dose cervical radiation had anastomotic separation, one requiring laryngectomy. One patient needed permanent tracheostomy, and temporary (<2 months) airway tubes were used in 5 patients. Sixteen patients received postoperative radiation. Median follow-up was 101 months. Four (16%) patients died of disease. Overall survival at 5 and 10 years was 79% and 64%, respectively. No patient underwent laryngectomy for recurrence.

CONCLUSION: Laryngotracheal resection and immediate reconstruction for subglottic tumors is achieved with good preservation of voice, low morbidity, and no compromise of long-term survival.






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