Superior Strategy in Benign Tracheal Stenosis Treatment: Surgery or Endoscopy?
Introduction Due to the variations in (laryngeal) tracheal stenosis (TS) patient groups, there is still no consensus on which patient should be treated with endoscopy or surgery. The aim of the present study was to generate an algorithm in the light of the related literature and the data obtained from a clinic where both endoscopic and surgical treatments are conducted.
Method A retrospective analysis was performed on the data of a total of 56 patients during 2013 to 2019. A total of 38 patients were subject to surgery with 31 as a first treatment option and 7 due to the unsatisfactory results of endoscopic treatments. Endoscopic approaches were tried on a total of 29 patients with 25 as initial treatment and 4 due to postsurgical recurrence.
Results Symptomatic full control ratio was determined as 69% with endoscopic treatments, 89.5% in subglottic stenosis (SGS) surgery (n = 19), and 89.5% in trachea surgery (n = 19). However, success rates with no recurrence were determined, respectively, as 40.0, 36.4, and 36.4% for patients subject to dilatation, stent, or T tube treatment. Dilatation was observed to be successful in patients with stenotic segment lengths of less than 1.5 cm (p = 0.02). Failure rates increased in SGS (p = 0.03) and TS (p = 0.12) in the surgical group with increasing stenotic segment length. The presence of comorbidities was not effective on treatment success.
Conclusion Endoscopic methods are preferred in cases of web-like stenosis. Surgical methods should first be considered for other patients and endoscopic methods should be used on patients who are not suited for surgery or in cases of postsurgical recurrence.
Received: 06 May 2020
Accepted: 09 June 2020
04 September 2020 (online)
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Heyes R, Cervantes SS, Matthaeus J, Jaroszewski D, Lott DG. Balloon dilation causing tracheal rupture: endoscopic management and literature review. Laryngoscope 2016; 126 (12) 2774-2777
- 2 Dalar L, Karasulu L, Abul Y. , et al. Bronchoscopic treatment in the management of benign tracheal stenosis: choices for simple and complex tracheal stenosis. Ann Thorac Surg 2016; 101 (04) 1310-1317
- 3 Puchalski J, Musani AI. Tracheobronchial stenosis: causes and advances in management. Clin Chest Med 2013; 34 (03) 557-567
- 4 Brigger MT, Boseley ME. Management of tracheal stenosis. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (06) 491-496
- 5 Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004; 169 (12) 1278-1297
- 6 Chhajed PN, Malouf MA, Glanville AR. Bronchoscopic dilatation in the management of benign (non-transplant) tracheobronchial stenosis. Intern Med J 2001; 31 (09) 512-516
- 7 D'Andrilli A, Maurizi G, Andreetti C. , et al. Long-term results of laryngotracheal resection for benign stenosis from a series of 109 consecutive patients. Eur J Cardiothorac Surg 2016; 50 (01) 105-109
- 8 El-Fattah AMA, Ebada HA, Amer HE, Abosamra MM, Tawfik A. Partial cricotracheal resection for severe upper tracheal stenosis: potential impacts on the outcome. Auris Nasus Larynx 2018; 45 (01) 116-122
- 9 Wright CD, Li S, Geller AD. , et al. Postintubation tracheal stenosis: management and results 1993 to 2017. Ann Thorac Surg 2019; 108 (05) 1471-1477
- 10 Atallah I, Aldkhyyal A, Castellanos PF. Modified single-stage segmental cricotracheal resection. Eur Arch Otorhinolaryngol 2018; 275 (01) 139-146
- 11 Pearson FG. Technique of management of subglottic stenosis. Chest Surg Clin N Am 1996; 6 (04) 683-692
- 12 Myer III CM, O'Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994; 103 (4 Pt 1): 319-323
- 13 Talwar R, Virk JS, Bajaj Y. Paediatric subglottic stenosis - have things changed? Our experience from a developing tertiary referral centre. Int J Pediatr Otorhinolaryngol 2015; 79 (12) 2020-2022
- 14 Yamamoto K, Kojima F, Tomiyama K, Nakamura T, Hayashino Y. Meta-analysis of therapeutic procedures for acquired subglottic stenosis in adults. Ann Thorac Surg 2011; 91 (06) 1747-1753
- 15 Roediger FC, Orloff LA, Courey MS. Adult subglottic stenosis: management with laser incisions and mitomycin-C. Laryngoscope 2008; 118 (09) 1542-1546
- 16 Kim JH, Shin JH, Song HY. , et al. Tracheobronchial laceration after balloon dilation for benign strictures: incidence and clinical significance. Chest 2007; 131 (04) 1114-1117
- 17 Galluccio G, Lucantoni G, Battistoni P. , et al. Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long-term follow-up. Eur J Cardiothorac Surg 2009; 35 (03) 429-433 , discussion 933–934
- 18 Brichet A, Verkindre C, Dupont J. , et al. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J 1999; 13 (04) 888-893
- 19 Montgomery WW. Silicone tracheal T-tube. Ann Otol Rhinol Laryngol 1974; 83 (01) 71-75
- 20 Cooper JD. Use of silicone tubes in the management of complex airway problems. Thorac Surg Clin 2018; 28 (03) 441-447
- 21 Prasanna Kumar S, Ravikumar A, Senthil K, Somu L, Nazrin MI. Role of Montgomery T-tube stent for laryngotracheal stenosis. Auris Nasus Larynx 2014; 41 (02) 195-200
- 22 Wang H, Wright CD, Wain JC, Ott HC, Mathisen DJ. Idiopathic subglottic stenosis: factors affecting outcome after single-stage repair. Ann Thorac Surg 2015; 100 (05) 1804-1811
- 23 Liberman M, Mathisen DJ. Tailored cricoplasty: an improved modification for reconstruction in subglottic tracheal stenosis. J Thorac Cardiovasc Surg 2009; 137 (03) 573-578 , discussion 578–579
- 24 Montgomery WW. Chronic subglottic stenosis. Otolaryngol Clin North Am 1984; 17 (01) 107-113
- 25 Bitar MA, Al Barazi R, Barakeh R. Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis. Rev Bras Otorrinolaringol (Engl Ed) 2017; 83 (03) 299-312
- 26 Hasan W, Gullane P. Laryngeal split and rib cartilage interpositional grafting: treatment option for glottic and subglottic stenosis in adults. Thorac Surg Clin 2018; 28 (02) 189-197
- 27 Axtell AL, Mathisen DJ. Idiopathic subglottic stenosis: techniques and results. Ann Cardiothorac Surg 2018; 7 (02) 299-305