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Long-term results of laryngotracheal resection for benign stenosis

^a Department of Thoracic Surgery, University of Rome ‘La Sapienza’, Sant’Andrea Hospital, Rome, Italy
^b Department of Thoracic Surgery, University of Rome ‘La Sapienza’, Policlinico Umberto I, Rome, Italy
^c Department of Anesthesiology, University of Rome ‘La Sapienza’, Sant’Andrea Hospital, Rome, Italy
^d Post-coma Division, St. Lucia Foundation, IRCSS, Rome, Italy

Received 21 August 2007; received in revised form 5 November 2007; accepted 6 December 2007.

^_* Corresponding author. Address: Department of Thoracic Surgery, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy. Tel.: +39 0633775773; fax: +39 0633775578. (Email: adandrilli{at}hotmail.com).

Objective: We report the long-term results of our 16-year experience with laryngotracheal resection for benign stenosis. Methods: Between 1991 and 2006, 35 consecutive patients (19 males, 16 females) underwent laryngotracheal resection for subglottic postintubation (32) or idiopathic (3) stenosis. Mean age was 43 years (range 14–71). At the time of surgery 13 patients presented with tracheostomy and 7 with a Dumon stent. The upper limit of the stenosis was from 0.6 to 1.5 cm below the vocal cords. The length of airway resection ranged between 1.5 and 6 cm. Suprahyoid release was performed in two patients and pericardial release in one. Nine patients had psychiatric and/or neurological post-coma disorders. Mean follow-up is over 5 years (61 months; range 3–194). Results: There was no perioperative mortality. Thirty patients (85.7%) had excellent or good anatomic and functional results. Four patients (11.4%) presented restenosis at a distance of 25–110 days from the operation. Restenosis was successfully treated by endoscopic procedures in all four patients. One patient (2.9%) presented anastomotic dehiscence that required temporary tracheostomy closed after 1 year with no sequelae. Three patients (8.4%) had wound infection. Long-term follow-up was uneventful also in patients who had early complications. Conclusions: Long-term follow-up confirms that laryngotracheal resection is the definitive curative treatment for benign subglottic stenosis. Surgical complications can be successfully managed by non-operative procedures. Despite the occurrence of early complications, excellent and stable results can still be obtained at long term.

Key Words: Laryngotracheal resection • Subglottic stenosis

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