Development of tracheal surgery: a historical review. Part 2: treatment of tracheal diseases
2003; Elsevier BV; Volume: 75; Issue: 3 Linguagem: Inglês
10.1016/s0003-4975(02)04109-7
ISSN1552-6259
Autores Tópico(s)Vascular Anomalies and Treatments
ResumoThis article is the second of a two-part historical review about the development of tracheal surgery. Part 1, "Techniques of Tracheal Surgery," appeared in the preceding issue of The Annals. Part 2 is a review of treatments of specific diseases of the trachea. There is, of course, considerable overlap. References for both parts are numbered sequentially. See "Selected References" at the end of this article for further explanation. Thus far, this review has focused on the evolution of techniques of tracheal surgery. Application of these and additional techniques to specific diseases of the airways will now be considered. The challenge of treating the rare tracheal tumors that were seen provided the initial stimulus for tracheal resection [1Belsey R. Resection and reconstruction of the intrathoracic trachea.Brit J Surg. 1950; 38: 200-205Crossref PubMed Google Scholar, 5Grillo H.C. Notes on the windpipe (Presidential address).Ann Thorac Surg. 1989; 47: 9-26Abstract Full Text PDF PubMed Google Scholar]. The very rarity of primary tracheal neoplasms, on the other hand, provided limited incentive to attack this problem systematically. In 1938, Culp [65Culp O.S. Primary carcinoma of trachea.J Thorac Surg. 1938; 7: 471-487Google Scholar] collected 433 reported cases of primary tracheal tumors, beginning with Lieutaud's discovery of fibroma at autopsy in 1767. From prior cumulative series, Culp noted the slow increment from 147 cases in 1898 to 201 in 1908, to 252 in 1914, and 351 in 1929. He provided an exhaustive bibliography, but personally found only one carcinoma in 9,000 autopsies at McGill University and one in 12,700 autopsies at Montreal General Hospital. Ellman and Whittaker [66Ellman P. Whittaker H. Primary carcinoma of the trachea.Thorax. 1947; 2: 151-161Crossref Google Scholar] raised the total to 507 in 1947. "Cylindroma" was often classified as adenocarcinoma, and tracheopathia osteoplastica was included as a tumor. Houston and colleagues [194Houston H.E. Payne W.S. Harrison Jr, E.G. Olsen A.M. Primary cancers of the trachea.Arch Surg. 1969; 99: 132-140Crossref PubMed Google Scholar] collected 53 primary cancers of trachea in more than 30 years at the Mayo Clinic, showing a distribution now recognized as expected: 45% squamous, 36% "cylindroma" (adenoid cystic carcinoma), and the balance of other origins, including mesenchymal tumors. Reporting a 30 years' experience in 1969, only two squamous cancers had been removed, one by lateral excision; six adenoid cystic cancer were also removed, none by circumferential resection and anastomosis and one mucoepidermoid by end-to-end repair. The next year, Hajdu and associates [195Hajdu S.I. Huvos A.G. Goodner J.T. et al.Carcinoma of the trachea Clinicopathologic study of 41 cases.Cancer. 1970; 25: 1448-1456Crossref PubMed Google Scholar] described 41 patients with primary tracheal carcinoma who were treated over a span of more than 33 years—30 squamous and seven adenoid cystic carcinomas. Few were treated by resection. Times were changing, however, as techniques of resection based on anatomic mobilization were increasingly applied to tracheal neoplasms. Forster and colleagues [73Forster E. Viville C. Moeller R. et al.Résection de la trachée. Suture bout a bout. Apropos de deux observations.Poumon Coeur. 1957; 13: 367-377PubMed Google Scholar] resected a cervical tracheal epithelioma in 1957 with end-to-end suture. Forster and Holderbach [196Forster E. Holderbach L. Rapport sur la chirurgie des tumeurs et des rétrécissements de la trachée.Poumon Coeur. 1960; 16: 33-119PubMed Google Scholar] in 1960 published a voluminous report on pathology and clinical presentation of tracheal tumors, and of experimental and a few clinical trials at that early date. Nonneoplastic lesions were also included. Grillo [85Grillo H.C. Circumferential resection and reconstruction of mediastinal and cervical trachea.Ann Surg. 1965; 162: 374-388Crossref PubMed Google Scholar] recounted treatment of three primary tumors by circumferential resection in 1965, using cross-table ventilation through the open trachea. Mathey and associates [41Mathey J. Binet J.P. Galey J.J. et al.Tracheal and tracheobronchial resections technique and results in 20 cases.J Thorac Cardiovasc Surg. 1966; 51: 1-13PubMed Google Scholar] reported resecting five primary tracheal neoplasms in 1966, with one early and one late postoperative death. Perelman and Korolyova [89Perelman M. Korolyova M. Surgery of tumors in the thoracic portion of the trachea.Thorax. 1968; 23: 307-310Crossref PubMed Google Scholar] successfully treated 5 patients with primary tracheal intrathoracic cancer by circular resection and anastomosis in 1968. They introduced an anesthesia tube into the left main bronchus through an incision in the membranous wall of the right main bronchus. Dor and associates [93Dor V. Kreitmann P. Arnaud A. et al.Résection étendue de la trachée pour tumeur et sténose.Presse Med. 1971; 79: 1843-1846PubMed Google Scholar] in 1971 resected tracheal tumors in 6 patients, with three postoperative deaths. By 1973, Grillo [197Grillo H.C. Reconstruction of the trachea. Experience in 100 consecutive cases.Thorax. 1973; 28: 667-679Crossref PubMed Google Scholar] had excised 11 primary tumors and five secondary tumors in a series of 100 tracheal resections with reconstruction. Nine of the 11 patients were alive without disease; 1 patient died after the operation. Experience with surgical management began to grow. In 1974, Eschapasse [128Eschapasse H. Les tumeurs trachéales primitives traitement chirurgical.Rev Fr Mal Respir. 1974; 2: 425-446Google Scholar] reported on 152 patients with primary tracheal tumors treated by 12 French and two Russian groups. Among the treatments were 32 circumferential resections and 18 carinal reconstructions. The highest postoperative mortality and the poorest long-term results were associated with squamous carcinoma. Adenoid cystic carcinoma showed prolonged survival, but late recurrence. Also in 1974, Pearson and associates [198Pearson F.G. Thompson D.W. Weissberg D. et al.Adenoid cystic carcinoma of the trachea. Experience with 16 patients managed by tracheal resection.Ann Thorac Surg. 1974; 18: 16-29Abstract Full Text PDF PubMed Scopus (0) Google Scholar] accomplished five resections of adenoid cystic carcinoma with primary anastomosis, without postoperative death. In 6 other patients, a prosthetic replacement was constructed with Marlex (Chevron Phillips Chemical Company LP, Houston, TX). Grillo [87Grillo H.C. Tracheal tumors surgical management.Ann Thorac Surg. 1978; 26: 112-125Abstract Full Text PDF PubMed Google Scholar] by 1978 reported seeing 63 patients with primary tumors. Nineteen patients with primary tumors (and 5 more with secondary tumors) underwent cylindrical resection and anastomosis; 10 patients underwent carinal resection and reconstruction; 10 underwent staged reconstruction; 10 underwent laryngotracheal resection or were treated by other means. Two patients died after cylindrical resection and 3 after carinal resection and reconstruction. Subsequent major series began to define the long-term oncologic expectation. Grillo and Mathisen [6Grillo H.C. Mathisen D.J. Primary tracheal tumors treatment and results.Ann Thorac Surg. 1990; 49: 69-77Abstract Full Text PDF PubMed Scopus (0) Google Scholar] in 1990 reported the largest single institutional series of 198 primary tumors treated at Massachusetts General Hospital over more than 26 years. Resection rates were 63% for squamous and 75% for adenoid cystic carcinoma. Pearson and colleagues [138Pearson F.G. Todd T.R.J. Cooper J.D. Experience with primary neoplasms of the trachea and carina.J Thorac Cardiovasc Surg. 1984; 88: 511-518PubMed Google Scholar] reported their experience with 44 tracheal tumors in 1984 and a subsequent report did the same for 38 adenoid cystic carcinomas [199Maziak D.E. Todd T.R.J. Keshavjee S.H. et al.Adenoid cystic carcinoma of the airway thirty-two-year experience.J Thorac Cardiovasc Surg. 1996; 112: 1522-1532Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar] in 1996. That same year, Regnard and colleagues [200Regnard J.F. Fourquier P. Levasseur P. Results and prognostic factors in resections of primary tracheal tumors a multicenter retrospective study.J Thorac Cardiovasc Surg. 1996; 111: 808-814Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar] provided an account of 208 patients in a multicenter series in France, and Perelman and colleagues [201Perelman M.I. Koroleva N. Birjukov J. Goudovsky L. Primary tracheal tumors.Sem Thorac Cardiovasc Surg. 1996; 8: 400-402PubMed Google Scholar] summarized their experience with 144 primary tumors. Squamous and adenoid cystic carcinoma together compose about three-quarters of all primary tracheal tumors, in comparable numbers. Squamous cancer of the trachea has behaved in etiology, curability, and associated aerodigestive carcinoma much like squamous lung cancer. Surgery for adenoid cystic carcinoma, combined with radiotherapy, improved 5-year survival rates, but was associated with a continued decrease in survival at 10 years and thereafter, because of local recurrence and the appearance of metastases. The idiosyncratic and prolonged course of the rare adenoid cystic carcinoma clearly requires prolonged observation for complete clinical definition. A wide variety of tumors of other histology, most often benign or of low-grade malignancy, compose the remaining one-quarter of cases of primary tracheal tumor [6Grillo H.C. Mathisen D.J. Primary tracheal tumors treatment and results.Ann Thorac Surg. 1990; 49: 69-77Abstract Full Text PDF PubMed Scopus (0) Google Scholar]. Operative mortality in all patients ranged from 5.3% to 10.5% in various series. Mortality and morbidity decreased with surgical experience [185Grillo HC, Zannini, and Michelassi F. Complications of tracheal reconstruction. J Thorac Cardiovasc Surg 1986;91:322–8Google Scholar], but remained highest for carinal reconstruction. Resection of the carina for bronchogenic carcinoma was discussed last month in Part 1 of this review (under "Carinal Pneumonectomy"). The trachea and lower larynx are susceptible to invasion by thyroid cancer because of the proximity of the gland [202Shin D.H. Mark E.J. Suen H.C. Grillo H.C. Pathological staging of papillary carcinoma of the thyroid with airway invasion based upon the anatomic manner of extension to the trachea A clinicopathologic study based on 22 patients who underwent thyroidectomy and airway resection.Hum Pathol. 1993; 24: 866-870Abstract Full Text PDF PubMed Scopus (44) Google Scholar]. Localized tracheal invasion by thyroid neoplasms has been resected episodically as tracheal surgery evolved. Rob and Bateman [31Rob C.G. Bateman G.H. Reconstruction of the trachea and cervical esophagus.Brit J Surg. 1949; 37: 202-205Crossref PubMed Google Scholar] in 1949 resected six rings of trachea and a portion of cricoid for recurrence of thyroid cancer "of low malignancy" 7 years after initial excision and radiotherapy. Tantalum gauze-fascia lata reconstruction was carried out, leaving a strip of posterior mucosa. After a checkered course, the patient survived. Conley [69Conley J.J. Reconstruction of the subglottic air passage.Ann Otol Rhinol laryngol. 1953; 62: 477-495PubMed Google Scholar] did a staged repair with tantalum mesh and fascia plus skin flaps after resection of anterior tracheal wall invaded by "adenocarcinoma of the thyroid." Lazo [203Lazo V.V. Resection of the cervical part of the trachea in cancer of the thyroid gland.Vopr onkol. 1957; 3: 635-636PubMed Google Scholar] in 1957 resected the anterior wall of cervical trachea to treat thyroid cancer, and implanted a prosthesis for speech. Grillo [85Grillo H.C. Circumferential resection and reconstruction of mediastinal and cervical trachea.Ann Surg. 1965; 162: 374-388Crossref PubMed Google Scholar] in 1965 resected a six-ring segment of trachea, including a portion of cricoid invaded by papillary carcinoma, which paralyzed the left cord and which obstructed the tracheal lumen. Tracheal reconstruction was staged with a cutaneous tube supported by inlying polypropylene rings. The result was satisfactory. In 1966, Mathey and colleagues [41Mathey J. Binet J.P. Galey J.J. et al.Tracheal and tracheobronchial resections technique and results in 20 cases.J Thorac Cardiovasc Surg. 1966; 51: 1-13PubMed Google Scholar] resected 3.5 cm of trachea for papillary carcinoma and performed an end-to-end anastomosis, but placed a tracheostomy in the suture line postoperatively. An aggressive approach was accepted early in Japan, but only slowly in the west. Ishihara and colleagues [204Ishihara T. Kikuchi K. Ikeda T. et al.Resection of thyroid carcinoma infiltrating the trachea.Thorax. 1978; 33: 378-386Crossref PubMed Google Scholar] in 1978 reported operative results for 11 patients, 8 of whom had recurrent papillary adenocarcinoma after prior surgery. Sleeve resections were done with resection of anterior cricoid in 3 patients. Two died from the operation and 3 developed laryngeal stenosis; 5 were long-term survivors. This same group reported on 60 patients by 1991 [205Ishihara T. Kobayashi K. Kikuchi J. et al.Surgical treatment of advanced thyroid carcinoma invading the trachea.J Thorac Cardiovasc Surg. 1991; 102: 717-720PubMed Google Scholar]. In 1985, Tsumori and colleagues [206Tsumori T. Nakae K. Miyata M. et al.Clinicopathologic study of thyroid carcinoma infiltrating the trachea.Cancer. 1985; 56: 2843-2848Crossref PubMed Scopus (32) Google Scholar] reported 18 resections with anastomosis. In 1986, Fujimoto and colleagues [207Fujimoto Y. Obara T. Ito Y. et al.Aggressive surgical approach for locally invasive papillary carcinoma of the thyroid in patients over forty-five years of age.Surgery. 1986; 100: 1098-1107PubMed Google Scholar] performed sleeve resection in 6 patients and window resection in 3. A survey of tracheobronchial surgery in Japan by Maeda and colleagues [208Maeda M. Nakamoto K. Ohta M. et al.Statistical survey of tracheobronchoplasty in Japan.J Thorac Cardiovasc Surg. 1989; 97: 402-414PubMed Google Scholar] in 1989 revealed 151 cases of tracheoplasty for thyroid cancer compared with 147 tracheobronchial tumors over a period of 30 years. In the west, Grillo [87Grillo H.C. Tracheal tumors surgical management.Ann Thorac Surg. 1978; 26: 112-125Abstract Full Text PDF PubMed Google Scholar] in 1978 reported on 3 patients who underwent resection for thyroid carcinoma and recommended that this treatment be applied more widely. In 1986, Grillo and Zannini [209Grillo H.C. Zannini P. Resectional management of airway invasion by thyroid carcinoma.Ann Thorac Surg. 1986; 42: 287-298Abstract Full Text PDF PubMed Google Scholar] described outcome of 16 patients who underwent resection and reconstruction, and Grillo and colleagues [210Grillo H.C. Suen H.C. Mathisen D.J. Wain J.C. Resectional management of thyroid carcinoma invading the airway.Ann Thorac Surg. 1992; 54: 3-10Abstract Full Text PDF PubMed Google Scholar] reported 27 by 1992. The rationale for resection and reconstruction is adherence to the oncologic principle of thyroid surgery, that local disease be removed totally. The surgery is not high risk or radical in competent hands. Given the proclivity of papillary tumors to become more aggressive in time, plus observation that many of these patients had undergone "shave" procedures, often years before, anything less than complete removal (including airway if necessary) seems inappropriate. Nonetheless, "shave" procedures in the case of superficial invasion and "window" resection in the case of deep invasion are still being recommended by surgeons without extensive experience in tracheal reconstruction [211Czaja J.M. McCaffrey T.V. The surgical management of laryngotracheal invasion of well-differentiated papillary thyroid carcinoma.Arch Otol Head Neck Surg. 1997; 123: 484-490Crossref PubMed Google Scholar]. Radical extirpation of invasive undifferentiated thyroid carcinoma and also of massive recurrences of papillary carcinoma, to include laryngectomy and extended tracheal resection, was described by Hendrick [212Hendrick J.W. An extended operation for thyroid carcinoma.Surg Gynecol Obstet. 1963; 116: 183-188PubMed Google Scholar] in 1963 in 11 patients with 5 long-term survivors and 5 alive without disease from 4 to 16 years. In 1958, Frazell and Foote [213Frazell E.L. Foote Jr, F.W. Papillary cancer of the thyroid a review of 25 years of experience.Cancer. 1958; 11: 895-922Crossref PubMed Google Scholar] noted 3 of 4 patients who had laryngeal and tracheal resection for thyroid cancer lived 4.5 to 5 years. Grillo and colleagues [210Grillo H.C. Suen H.C. Mathisen D.J. Wain J.C. Resectional management of thyroid carcinoma invading the airway.Ann Thorac Surg. 1992; 54: 3-10Abstract Full Text PDF PubMed Google Scholar] in 1986 reported radical extirpation of tumor in 7 patients by cervicomediastinal exenteration including esophagectomy. Palliation is a principal goal of these procedures. The poliomyelitis epidemics of the mid-20th century introduced and led to an ever-widening use of mechanical ventilators to treat respiratory failure. The iatrogenic lesions that resulted provided a whole new field of endeavor for the tracheal surgeon. Gradually, a spectrum of lesions was recognized that was attributable to ventilatory apparatus–endotracheal and tracheostomy tubes and the cuffs necessary to seal the trachea [86Grillo H.C. The management of tracheal stenosis following assisted respiration.J Thorac Cardiovasc Surg. 1969; 57: 52-71PubMed Google Scholar, 92Pearson F.G. Andrews M.J. Detection and management of tracheal stenosis following cuffed tube tracheostomy.Ann Thorac Surg. 1971; 12: 359-374Abstract Full Text PDF PubMed Google Scholar, 188Aboulker P. Lissac J. saint-Paul O. De quelques accidents respiratoires dus au rétrécissement du calibre laryngo-trachéal asprès trachéotomie.Acta Chir Belg. 1960; 59: 553-561PubMed Google Scholar, 214Pearson F.G. Goldberg M. daSilva A.J. Tracheal stenosis complicating tracheostomy with cuffed tubes Clinical experience and observations from a prospective study.Arch Surg. 1968; 97: 380-394Crossref PubMed Google Scholar]. Principal among these lesions were circumferential stenosis, which appeared at the level of the sealing cuff, and anteriorly pointed, arrow-shaped stenosis, which occurred at the stomal level. Additionally, granulomas occurred at the point where a tube tip impinged on the tracheal wall. Areas of malacia were seen less often at the level of the cuff and sometimes in the segment between a tracheal stoma and a cuff stenosis. Tracheoesophageal fistulas occurred principally between the trachea and the esophagus at cuff level, usually with accompanying circumferential tracheal damage. Tracheal innominate artery fistulas were rare but disastrous when they occurred. These fistulas proved to be of two types, one in which a tracheostomy tube rested immediately on the innominate artery near the stoma, and another, in which the cuff or, even less often, the tube tip eroded through the trachea anteriorly into the innominate artery. In the 1960s, numerous articles, often single case reports, appeared in Europe and North America describing surgical resection of postintubation strictures. Included among these were: Forster [73Forster E. Viville C. Moeller R. et al.Résection de la trachée. Suture bout a bout. Apropos de deux observations.Poumon Coeur. 1957; 13: 367-377PubMed Google Scholar] in 1957, Flavell [77Flavell G. Resection of tracheal stricture following tracheostomy with primary anastomosis.Proc Roy Soc Med. 1959; 52: 143-145PubMed Google Scholar] in 1959, Witz [215Witz J.P. Greiner G. Reys P. Lang S. Complication rare de la trachéotomie. Sténose basse de la trachée thoracique.Mém Acad Chir. 1960; 86: 123-128PubMed Google Scholar] in 1960, Binet and Aboulker [75Binet J.P. Aboulker P. Un cas de sténose trachéal apres trachéotomie. Résection-suture de la trachée.Guérison Mém Acad Chir. 1961; 87: 39-42Google Scholar] in 1961, Van Wien [216Van Wien A. DeClercq F. Van Eych M. Reinhold H. Tracheal stenosis after tracheostomy.Acta Chir Belg. 1961; 60: 85-93PubMed Google Scholar] in 1961, Mathey [41Mathey J. Binet J.P. Galey J.J. et al.Tracheal and tracheobronchial resections technique and results in 20 cases.J Thorac Cardiovasc Surg. 1966; 51: 1-13PubMed Google Scholar] in 1966, Byrn [217Byrn F.M. Davies C.K. Harrison G.K. Tracheal stenosis following tracheostomy a case report.Br J Anaesth. 1967; 39: 171-173Crossref PubMed Scopus (1) Google Scholar] and Fraser [218Fraser K. Bell P.R.F. Distal tracheal stenosis following tracheostomy.Br J Surg. 1967; 54: 302-303Crossref PubMed Google Scholar] in 1967, Jewsbury [219Jewsbury P. Resection of tracheal stricture following tracheostomy.Lancet. 1969; 2: 411-413Abstract PubMed Google Scholar], Dor [220Dor J. Dor V. Malmejac C. et al.Résection-suture de la trachée cervico-thoracique pour sténose post-trachéotomie. Controle éloigné de trois observations.Ann Chir. 1969; 23: 177-182PubMed Google Scholar], Dolton [221Dolton E.G. Resection of tracheal strictures.Lancet. 1969; 2: 544Abstract PubMed Google Scholar], Schaudig [222Schaudig A. Tracheal resektion bei benigner und maligner Stenose.Thoraxchir. 1969; 17: 508-511Google Scholar], Lindholm [223Lindholm C.-E. Prolonged endotracheal intubation.Acta anaesth Scand. 1969; : 1-131Crossref PubMed Google Scholar], and Naef [90Naef A.P. Extensive tracheal resection and tracheobronchial reconstruction.Ann Thorac Surg. 1969; 8: 391-401Abstract Full Text PDF PubMed Google Scholar] in 1969, along with their colleagues. Series of cases also were reported: Deverall [88Deverall P.B. Tracheal stricture following tracheostomy.Thorax. 1967; 22: 572-576Crossref PubMed Google Scholar] detailed 6 patients in 1967, Pearson [214Pearson F.G. Goldberg M. daSilva A.J. Tracheal stenosis complicating tracheostomy with cuffed tubes Clinical experience and observations from a prospective study.Arch Surg. 1968; 97: 380-394Crossref PubMed Google Scholar] 15 patients in 1968, Grillo [86Grillo H.C. The management of tracheal stenosis following assisted respiration.J Thorac Cardiovasc Surg. 1969; 57: 52-71PubMed Google Scholar] 14 patients and Couraud [91Couraud L. Chevalier P. Bruneteau A. DuPont P. Le traitement des sténoses trachéales après trachéotomie.Ann Chir Thor Card. 1969; 8: 351-357Google Scholar] 9 patients in 1969, Dor [93Dor V. Kreitmann P. Arnaud A. et al.Résection étendue de la trachée pour tumeur et sténose.Presse Med. 1971; 79: 1843-1846PubMed Google Scholar] 9 patients, Levasseur [94Levasseur P. Rojas-Miranda A. Kulski M. et al.Les complications de la chirurgie des sténoses trachéales non tumorales.Ann Chir Thorac Cardiovasc. 1971; 10: 393-398PubMed Google Scholar] 10 patients, and Harley [95Harley H.R.S. Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration. A critical review.Thorax. 1971; 26: 493-533Crossref PubMed Google Scholar] 11 patients in 1971. These last authors, especially Pearson, Grillo, and Harley, having somewhat broader experience, defined the anatomic and pathologic differences between stomal and cuff stenoses and other postintubation injuries and discussed their pathogenesis. Malacia instead of stenosis was also described, although a rare finding by Grillo [224Grillo H.C. Surgical treatment of postintubation tracheal injuries.J Thorac Cardiovasc Surg. 1979; 78: 860-875PubMed Google Scholar]. Deverall [88Deverall P.B. Tracheal stricture following tracheostomy.Thorax. 1967; 22: 572-576Crossref PubMed Google Scholar], Pearson [214Pearson F.G. Goldberg M. daSilva A.J. Tracheal stenosis complicating tracheostomy with cuffed tubes Clinical experience and observations from a prospective study.Arch Surg. 1968; 97: 380-394Crossref PubMed Google Scholar], Grillo [86Grillo H.C. The management of tracheal stenosis following assisted respiration.J Thorac Cardiovasc Surg. 1969; 57: 52-71PubMed Google Scholar], and Couraud [91Couraud L. Chevalier P. Bruneteau A. DuPont P. Le traitement des sténoses trachéales après trachéotomie.Ann Chir Thor Card. 1969; 8: 351-357Google Scholar] and their colleagues stressed the importance of allowing florid inflammation to subside before surgical correction. Their generally good results showed the superiority of definitive surgical resection and anastomosis over prior alternative methods of treatment, such as repetitive dilation, steroid injection, or cryotherapy. Unfortunately, the lesson is being relearned today, with uncritical use of laser surgery for these lesions [225Shapshay S.M. Beamis J.F. Hybels R.I. et al.Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation.Ann Otol Rhinol Laryngol. 1987; 96: 661-664PubMed Google Scholar], and, more lately with much more disastrous results, the attempted use of stents [193Grillo H.C. Stents and sense.Ann Thorac Surg. 2000; 70 ([Editorial]): 1139Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar] to treat postintubation stenosis. Postintubation lesions became, and remain, the most common indication for tracheal resection and reconstruction. Generally good results have been obtained in major cumulative series of patients with iatrogenic tracheal and subglottic laryngotracheal stenosis: Bisson and colleagues [226Bisson A. Bonnette P. El Kadi B. et al.Tracheal sleeve resection for iatrogenic stenosis (subglottic laryngeal and tracheal).J Thorac Cardiovasc Surg. 1992; 104: 882-887PubMed Google Scholar] achieved 87.5% "cure" in 200 patients in 1992, Couraud and colleagues [227Couraud L. Jougon J. Velly J.F. Klein C. Sténoses iatrogênes de la voie respiratoire. Evolution des indications thérapentiques.Ann Chir Thorac Cardiovasc. 1994; 48: 277-283Google Scholar] achieved 96% success in 217 patients in 1994, and Grillo and colleagues [100Grillo H.C. Donahue D.M. Mathisen D.J. et al.Postintubation tracheal stenosis treatment and results.J Thorac Cardiovasc Surg. 1995; 109: 486-493Abstract Full Text Full Text PDF PubMed Scopus (231) Google Scholar] achieved 94% success in 503 patients in 1995. Correction of postintubation stenosis involving the subglottic larynx remains more difficult than lesions confined to trachea. The evolution of procedures for laryngotracheal resection and reconstruction by partial cricoid resection has been outlined and their application to iatrogenic stenosis noted. Monnier and associates [169Monnier P. Savary M. Chapuis G. Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children.Laryngoscope. 1993; 103: 1273-1283Crossref PubMed Google Scholar] applied this approach in infants and children, also with encouraging success. Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis proved to be surprisingly manageable. Donahue and colleagues [228Donahue D.M. Grillo H.C. Wain J.C. et al.Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis.J Thorac Cardiovasc Surg. 1997; 114: 934-939Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar] in 1997 tallied 92% good or satisfactory results in 75 patients who had failed prior surgical repairs, 59 of whom were referred. Tracheoesophageal fistula due to erosion by tracheal cuffs and often of "giant" size were noted early, in 1966 by Le Brigand and Roy [229Le Brigand H. Roy B. Fistules trachéo-oesophagiennes après trachéotomies à propos de 4 observations.Mem Acad Chir. 1966; 92: 405-416PubMed Google Scholar] and several other French surgeons during the same period, Flege [230Flege Jr, J.B. Tracheoesophageal fistula caused by cuffed tracheostomy tube.Ann Surg. 1967; 166: 153-156Crossref PubMed Google Scholar] in 1967, and Hedden and colleagues [231Hedden M. Ersoz C.J. Safar P. Tracheo-esophageal fistulas following prolonged artificial ventilation via cuffed tracheostomy tubes.Anesthesiol. 1969; 31: 281-289Crossref PubMed Google Scholar] in 1969. Scattered attempts of repair by sometimes multistaged techniques, including Braithwaite's [232Braithwaite F. Closure of a tracheo-oesophageal fistula.Brit J Plast Surg. 1961; 14: 138-143Abstract Full Text PDF Google Scholar] successful use of a cutaneous flap to seal the tracheal side of a large fistula in 1961, did not often meet with success [229Le Brigand H. Roy B. Fistules trachéo-oesophagiennes après trachéotomies à propos de 4 observations.Mem Acad Chir. 1966; 92: 405-416PubMed Google Scholar, 233Thomas A.N. The diagnosis and treatment of tracheoesophageal fistula caused by cuffed tracheal tubes.J Thorac Cardiovasc Surg. 1973; 65: 612-619PubMed Google Scholar]. Grillo and associates [234Grillo H.C. Moncure A.C. McEnany M.T. Repair of inflammatory tracheoesophageal fistula.Ann Thorac Surg. 1976; 22: 112-119Abstract Full Text PDF PubMed Google Scholar] in 1976 described a definitive one-stage technique for esophageal closure, tracheal resection (in which a circumferential cuff lesion was present), and strap muscle interposition, with good results in 7 patients. Postintubation injury, however infrequent, has become the most frequent cause of acquired tracheoesophageal fistula. It is now effectively managed by the type of procedure noted, and has been further described [235Mathisen D.J. Grillo H.C. Wain J.C. Hilgenberg A.D. Management of acquired nonmalignant tracheoesophageal fistula.Ann Thorac Surg. 1991; 52: 759-765Abstract Full Text PDF PubMed Google Scholar, 236Couraud L. Bercovici D. Zanotti L. et al.Treatment of oesophago-tracheal fistula secondary to respiratory intensive care. Report of seventy cases.Ann Chir. 1989; 43: 677-681PubMed Google Scholar, 237Macchiarini P. Verhoye J.P. 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