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Eur J Cardiothorac Surg 2004;26:459-460
© 2004 Elsevier Science NL

Letter to the Editor

Upper trachea sleeve resection and anastomosis for invasive thyroid carcinoma¹

^a Thoracic Surgery Division, University of Eastern Piedmont, ‘Maggiore della Carità’ General Hospital, C.so Mazzini 18, I-28100 Novara, Italy
^b Thoracic Surgery Division, University of Torino, ‘Molinette’ General Hospital, via Genova 3, I-10126 Torino, Italy

Received 13 March 2004; accepted 30 April 2004.

^* Corresponding author. Tel.: +39-0321-3733-363; fax: +39-0321-3733-578
e-mail: ottavio.rena{at}tiscalinet.it

Key Words: Tracheoplasty • Anastomosis • Partial sternotomy

We read with interest the paper of S. Watanabe et al. about the surgical management of a thyroid carcinoma invading the upper half of the tracheal wall [1].

Authors performed total thyroidectomy through a cervical collar incision and sleeve tracheal resection (six rings, from second to seventh—4.2 cm length) with subsequent tracheal anastomosis through an L-shaped unilateral right-sided mini-sternotomy (8 cm midline skin incision). Pratically they carried out a cervical collar incision added with minimally modified upper partial sternotomy (the sternum was divided from the suprasternal notch to the third intercostal space—the upper half of it).

The feasibility of the procedure through the described limited surgical incision warranting little postoperative pain, short hospital stay (the postoperative recovery duration is not reported) and excellent cosmetic result is emphasized.

Since 1970s, it is well known that circumferential resections of the upper half of the trachea are easily performed through cervical incision associated, if required, with upper partial median sternotomy [2–4]. It has been largely demonstrated that tracheal resections of 4.5 cm or less are safely performed with the only aid of a postoperative cervical flexion which causes minimal discomfort to the patient but warrants the less incidence of anastomotic dehiscence or stenosis [2–4].

At the end of the intervention, the suture line was wrapped with a flap of tissue dissected from the right lobe of the thymus: this procedure is described as useful, effective and less invasive than using an omental flap requiring the opening of the abdominal cavity.

It has to be remarked that the utilization of omental flaps to reinforce the tracheal or bronchial anastomosis is not actually so diffused; this procedure has been largely utilized at the beginning of the lung transplantation era when bronchial sutures were reinforced and divided from the vascular ones using pedicled great omentum but, in our knowledge, it has been quite abandoned because of the associated co-morbidity of the abdominal intervention [5].

When the reinforcement of the bronchial or tracheal suture is requested, it can be easily carried out using intrathoracic or cervical tissues (pedicled neck muscle, fatty or connective tissue of the mediastinum, thymic tissue, pleural or pericardial flap, pedicled intercostal muscle, according to the type of surgical exposition). In the surgery of the upper trachea, the cervical anastomosis rarely requires to be reinforced [2–4]. Reinforcement and interposition of pedicled muscular flaps such as sternohyoid or sternothyroid between the tracheal and oesophageal or arterial sutures is recommended only during the surgical repair of tracheo-oesophageal or tracheo-innominate fistulas [3].

The utilization of the right lobe of the thymus to wrap the tracheal suture is only one of the technical options allowed by the described surgical access but there are no clear reasons to prefer this technique to others.

Concluding, we have to congratulate the authors for the good procedure they refer and the obtained results, but we think that they do not describe any innovation in the surgical management of tumours invading the upper half of the trachea.

Footnotes

¹ The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer.

References

1. Watanabe S., Takagi K., Nakamura Y., Sakata R. Tracheal release and thymus wrapping of the tracheoplasty anastomosis through mini-sternotomy. Eur J Cardiothorac Surg 2004;25:287-289.[Abstract/Free Full Text]
2. Grillo H.C. Reconstruction of the trachea. Experience in 100 consecutive cases. Thorax 1973;28:667-679.[Medline]
3. Grillo H.C. Surgical treatment of postintubation tracheal injuries. J Thorac Cardiovasc Surg 1979;78:860-875.[Abstract]
4. Grillo H.C., Mathisen D.J. Primary tracheal tumors: treatment and results. Ann Thorac Surg 1990;49:69-77.[Abstract]
5. Cooper J.D., Pearson F.G., Patterson G.A., Todd T.R., Ginsberg R.J., Goldberg M., DeMajo W.A. Technique of successful lung transplantation in humans. J Thorac Cardiovasc Surg 1987;93:173-181.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giuliano Maggi Caterina Casadio Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rena, O. Articles by Casadio, C. Search for Related Content PubMed PubMed Citation Articles by Rena, O. Articles by Casadio, C. Related Collections Trachea and bronchi