Perioperative anastomotic management strategies for tracheal reconstruction surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Chudong ^1,2 , HU Biao ^2,3 , XIANG Binbin ³ , LIANG Yunjuan ¹ ,  LI Shuben ^1,2

1. Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, P. R. China;
2. State Key Laboratory of Respiratory Disease & National Center for Respiratory Medicine, Guangzhou, 510120, P. R. China;
3. Guangzhou Medical University, Guangzhou, 510000, P. R. China;

Corresponding author：

LI Shuben, Email: 13500030280@163.com

Keywords：

Tracheal reconstruction surgery; anastomotic management; anastomotic complications; perioperative period; review

DOI：

10.7507/1007-4848.202410074

Video：

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In tracheal resection and reconstruction, a technically demanding, complex, and high-risk procedure, management of the anastomotic site significantly impacts postoperative outcomes and long-term quality of life. However, comprehensive studies detailing perioperative anastomotic management strategies in tracheal reconstruction remain scarce. This review summarizes perioperative management strategies for tracheal reconstruction, covering preoperative assessment, surgical techniques, and other key aspects. It also highlights future research directions and challenges, aiming to provide clinicians with a systematic guide to perioperative management in tracheal reconstruction.

1.	Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: Prevention and treatment. J Thorac Dis, 2016, 8(Suppl 2): S160-S167.
2.	Wright CD, Grillo HC, Wain JC, et al. Anastomotic complications after tracheal resection: Prognostic factors and management. J Thorac Cardiovasc Surg, 2004, 128(5): 731-739.
3.	Grillo HC. Development of tracheal surgery: A historical review. Part 2: Treatment of tracheal diseases. Ann Thorac Surg, 2003, 75(3): 1039-1047.
4.	Cooper JD. Surgery of the airway: Historic notes. J Thorac Dis, 2016, 8(Suppl 2): S113-S120.
5.	Grillo HC. Development of tracheal surgery: A historical review. Part 1: Techniques of tracheal surgery. Ann Thorac Surg, 2003, 75(2): 610-619.
6.	Mulliken JB, Grillo HC. The limits of tracheal resection with primary anastomosis: Further anatomical studies in man. J Thorac Cardiovasc Surg, 1968, 55(3): 418-421.
7.	Rosen FS, Pou AM, Buford WL. Tracheal resection with primary anastomosis in cadavers: The effects of releasing maneuvers and length of tracheal resection on tension. Ann Otol Rhinol Laryngol, 2003, 112(10): 869-876.
8.	Ziaian B, Shahriarirad R, Fouladi D, et al. The effect of suture techniques on the outcome of tracheal reconstruction: An observational study and review of literature. Surgeon, 2023, 21(2): e89-e96.
9.	Mathisen DJ. Tracheal resection and reconstruction: How I teach it. Ann Thorac Surg, 2017, 103(4): 1043-1048.
10.	Saetti R, Ronzani G, Meneghesso S, et al. Operative technique: Tracheal resection and anastomosis in a revision surgery. Head Neck, 2023, 45(10): 2730-2734.
11.	Wright CD, Li S, Geller AD, et al. Postintubation tracheal stenosis: Management and results 1993 to 2017. Ann Thorac Surg, 2019, 108(5): 1471-1477.
12.	Bibas BJ, Terra RM, Oliveira Junior AL, et al. Predictors for postoperative complications after tracheal resection. Ann Thorac Surg, 2014, 98(1): 277-282.
13.	Manning PB. Tracheal reconstruction in the pediatric population: How I teach it. Ann Thorac Surg, 2017, 104(6): 1770-1773.
14.	Macchiarini P. Primary tracheal tumours. Lancet Oncol, 2006, 7(1): 83-91.
15.	Aydogmus U, Kis A, Ugurlu E, et al. Superior strategy in benign tracheal stenosis treatment: Surgery or endoscopy? Thorac Cardiovasc Surg, 2021, 69(8): 756-763.
16.	Axtell AL, Mathisen DJ. Idiopathic subglottic stenosis: Techniques and results. Ann Cardiothorac Surg, 2018, 7(2): 299-305.
17.	Ashiku SK, Kuzucu A, Grillo HC, et al. Idiopathic laryngotracheal stenosis: Effective definitive treatment with laryngotracheal resection. J Thorac Cardiovasc Surg, 2004, 127(1): 99-107.
18.	Li S, Ai Q, Liang H, et al. Nonintubated robotic-assisted thoracic surgery for tracheal/airway resection and reconstruction: Technique description and preliminary results. Ann Surg, 2022, 275(2): e534-e536.
19.	Richardson CM, Hart CK, Johnson KE, et al. Slide tracheoplasty: Complete tracheal rings and beyond. Otolaryngol Clin North Am, 2022, 55(6): 1253-1270.
20.	Broussard B, Mathisen DJ. Tracheal release maneuvers. Ann Cardiothorac Surg, 2018, 7(2): 293-298.
21.	Madariaga MLL, Soni ML, Mathisen DJ, et al. Evaluation of release maneuvers after airway reconstruction. Ann Thorac Surg, 2022, 113(2): 406-412.
22.	He J, Zhong Y, Suen HC, et al. The procedure and effectiveness of release maneuvers in tracheobronchial resection and reconstruction. Transl Lung Cancer Res, 2022, 11(6): 1154-1164.
23.	He J, Xu X, Lan L, et al. End-to-side anastomosis in complex tracheal resection and reconstruction: A case series study. Transl Lung Cancer Res, 2022, 11(2): 165-172.
24.	Gozen ED, Yener M, Erdur ZB, et al. End-to-end anastomosis in the management of laryngotracheal defects. J Laryngol Otol, 2017, 131(5): 447-454.
25.	Costantino CL, Geller AD, Wright CD, et al. Carinal surgery: A single-institution experience spanning 2 decades. J Thorac Cardiovasc Surg, 2019, 157(5): 2073-2083.
26.	Wang C, Dong J, Zhuang X, et al. Intraoperative methods for wrapping anastomoses after airway reconstruction: A case series. Transl Lung Cancer Res, 2022, 11(6): 1145-1153.
27.	Zhou Y, Liang H, Xu K, et al. The strategy of non-intubated spontaneous ventilation anesthesia for upper tracheal surgery: A retrospective case series study. Transl Lung Cancer Res, 2022, 11(5): 880-889.
28.	Sagan D, Sak J, Wiechetek M, et al. Differences in psychological perception of lung cancer between patients, medical staff and medical students. Eur J Cardiothorac Surg, 2012, 41(3): 607-611.
29.	Clunie GM, Roe JWG, Alexander C, et al. Voice and swallowing outcomes following airway reconstruction in adults: A systematic review. Laryngoscope, 2021, 131(1): 146-157.
30.	Clunie GM, Kinshuck AJ, Sandhu GS, et al. Voice and swallowing outcomes for adults undergoing reconstructive surgery for laryngotracheal stenosis. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(3): 195-199.
31.	Bibas BJ, Guerreiro Cardoso PF, Minamoto H, et al. Surgical management of benign acquired tracheoesophageal fistulas: A ten-year experience. Ann Thorac Surg, 2016, 102(4): 1081-1087.
32.	Tazuke Y, Okuyama H, Uehara S, et al. Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction. J Pediatr Surg, 2015, 50(12): 2009-2011.
33.	Timman ST, Schoemaker C, Li WWL, et al. Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis. Ann Cardiothorac Surg, 2018, 7(2): 227-236.
34.	Lennon CJ, Gelbard A, Bartow C, et al. Dysphagia following airway reconstruction in adults. JAMA Otolaryngol Head Neck Surg, 2016, 142(1): 20-24.
35.	Tayfun MA, Eren E, Başoğlu MS, et al. Postintubation laryngotracheal stenosis: Assessing the success of surgery. J Craniofac Surg, 2013, 24(5): 1716-1719.
36.	Lui CG, Bensoussan Y, Pei M, et al. Factors associated with dysphagia in patients undergoing tracheal resection. JAMA Otolaryngol Head Neck Surg, 2023, 149(6): 505-511.
37.	Rahimi N, Roesner I, Schweiger T, et al. Functional evaluation before and after laryngo-tracheal resection. Transl Cancer Res, 2020, 9(3): 2142-2148.
38.	Nauta A, Mitilian D, Hanna A, et al. Long-term results and functional outcomes after surgical repair of benign laryngotracheal stenosis. Ann Thorac Surg, 2021, 111(6): 1834-1841.
39.	Sihag S, Wright CD. Prevention and management of complications following tracheal resection. Thorac Surg Clin, 2015, 25(4): 499-508.
40.	Cardoso PFG, Bibas BJ, Minamoto H, et al. Prophylaxis and treatment of complications after tracheal resection. Thorac Surg Clin, 2018, 28(2): 227-241.
41.	Tapias LF, Mathisen DJ. Prevention and management of complications following tracheal resections-lessons learned at the Massachusetts General Hospital. Ann Cardiothorac Surg, 2018, 7(2): 237-243.
42.	Stock C, Gukasyan N, Muniappan A, et al. Hyperbaric oxygen therapy for the treatment of anastomotic complications after tracheal resection and reconstruction. J Thorac Cardiovasc Surg, 2014, 147(3): 1030-1035.
43.	Konen E, Yellin A, Greenberg I, et al. Complications of tracheal and thoracic surgery: The role of multisection helical CT and computerized reformations. Clin Radiol, 2003, 58(5): 341-350.
44.	Heyer CM, Nuesslein TG, Jung D, et al. Tracheobronchial anomalies and stenoses: Detection with low-dose multidetector CT with virtual tracheobronchoscopy—Comparison with flexible tracheobronchoscopy. Radiology, 2007, 242(2): 542-549.
45.	Wang R, Gonzalez-Rivas D, Wang C, et al. Non-intubated uniportal robotic-assisted thoracic surgery: the future of thoracic surgery? Ann Cardiothorac Surg, 2023, 12(1): 49-51.
46.	Lee HY, Lee JW. Current status and future outlook of additive manufacturing technologies for the reconstruction of the trachea. J Funct Biomater, 2023, 14(4): 196.
47.	Sun Y, Huo Y, Ran X, et al. Instant trachea reconstruction using 3D-bioprinted C-shape biomimetic trachea based on tissue-specific matrix hydrogels. Bioact Mater, 2023, 32: 52-65.
48.	Crowley C, Birchall M, Seifalian AM. Trachea transplantation: From laboratory to patient. J Tissue Eng Regen Med, 2015, 9(4): 357-367.
49.	Sun F, Lu Y, Wang Z, et al. Directly construct microvascularization of tissue engineering trachea in orthotopic transplantation. Mater Sci Eng C Mater Biol Appl, 2021, 128: 112201.
50.	Kuss MA, Wu S, Wang Y, et al. Prevascularization of 3D printed bone scaffolds by bioactive hydrogels and cell co-culture. J Biomed Mater Res B Appl Biomater, 2018, 106(5): 1788-1798.

1. Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: Prevention and treatment. J Thorac Dis, 2016, 8(Suppl 2): S160-S167.
2. Wright CD, Grillo HC, Wain JC, et al. Anastomotic complications after tracheal resection: Prognostic factors and management. J Thorac Cardiovasc Surg, 2004, 128(5): 731-739.
3. Grillo HC. Development of tracheal surgery: A historical review. Part 2: Treatment of tracheal diseases. Ann Thorac Surg, 2003, 75(3): 1039-1047.
4. Cooper JD. Surgery of the airway: Historic notes. J Thorac Dis, 2016, 8(Suppl 2): S113-S120.
5. Grillo HC. Development of tracheal surgery: A historical review. Part 1: Techniques of tracheal surgery. Ann Thorac Surg, 2003, 75(2): 610-619.
6. Mulliken JB, Grillo HC. The limits of tracheal resection with primary anastomosis: Further anatomical studies in man. J Thorac Cardiovasc Surg, 1968, 55(3): 418-421.
7. Rosen FS, Pou AM, Buford WL. Tracheal resection with primary anastomosis in cadavers: The effects of releasing maneuvers and length of tracheal resection on tension. Ann Otol Rhinol Laryngol, 2003, 112(10): 869-876.
8. Ziaian B, Shahriarirad R, Fouladi D, et al. The effect of suture techniques on the outcome of tracheal reconstruction: An observational study and review of literature. Surgeon, 2023, 21(2): e89-e96.
9. Mathisen DJ. Tracheal resection and reconstruction: How I teach it. Ann Thorac Surg, 2017, 103(4): 1043-1048.
10. Saetti R, Ronzani G, Meneghesso S, et al. Operative technique: Tracheal resection and anastomosis in a revision surgery. Head Neck, 2023, 45(10): 2730-2734.
11. Wright CD, Li S, Geller AD, et al. Postintubation tracheal stenosis: Management and results 1993 to 2017. Ann Thorac Surg, 2019, 108(5): 1471-1477.
12. Bibas BJ, Terra RM, Oliveira Junior AL, et al. Predictors for postoperative complications after tracheal resection. Ann Thorac Surg, 2014, 98(1): 277-282.
13. Manning PB. Tracheal reconstruction in the pediatric population: How I teach it. Ann Thorac Surg, 2017, 104(6): 1770-1773.
14. Macchiarini P. Primary tracheal tumours. Lancet Oncol, 2006, 7(1): 83-91.
15. Aydogmus U, Kis A, Ugurlu E, et al. Superior strategy in benign tracheal stenosis treatment: Surgery or endoscopy? Thorac Cardiovasc Surg, 2021, 69(8): 756-763.
16. Axtell AL, Mathisen DJ. Idiopathic subglottic stenosis: Techniques and results. Ann Cardiothorac Surg, 2018, 7(2): 299-305.
17. Ashiku SK, Kuzucu A, Grillo HC, et al. Idiopathic laryngotracheal stenosis: Effective definitive treatment with laryngotracheal resection. J Thorac Cardiovasc Surg, 2004, 127(1): 99-107.
18. Li S, Ai Q, Liang H, et al. Nonintubated robotic-assisted thoracic surgery for tracheal/airway resection and reconstruction: Technique description and preliminary results. Ann Surg, 2022, 275(2): e534-e536.
19. Richardson CM, Hart CK, Johnson KE, et al. Slide tracheoplasty: Complete tracheal rings and beyond. Otolaryngol Clin North Am, 2022, 55(6): 1253-1270.
20. Broussard B, Mathisen DJ. Tracheal release maneuvers. Ann Cardiothorac Surg, 2018, 7(2): 293-298.
21. Madariaga MLL, Soni ML, Mathisen DJ, et al. Evaluation of release maneuvers after airway reconstruction. Ann Thorac Surg, 2022, 113(2): 406-412.
22. He J, Zhong Y, Suen HC, et al. The procedure and effectiveness of release maneuvers in tracheobronchial resection and reconstruction. Transl Lung Cancer Res, 2022, 11(6): 1154-1164.
23. He J, Xu X, Lan L, et al. End-to-side anastomosis in complex tracheal resection and reconstruction: A case series study. Transl Lung Cancer Res, 2022, 11(2): 165-172.
24. Gozen ED, Yener M, Erdur ZB, et al. End-to-end anastomosis in the management of laryngotracheal defects. J Laryngol Otol, 2017, 131(5): 447-454.
25. Costantino CL, Geller AD, Wright CD, et al. Carinal surgery: A single-institution experience spanning 2 decades. J Thorac Cardiovasc Surg, 2019, 157(5): 2073-2083.
26. Wang C, Dong J, Zhuang X, et al. Intraoperative methods for wrapping anastomoses after airway reconstruction: A case series. Transl Lung Cancer Res, 2022, 11(6): 1145-1153.
27. Zhou Y, Liang H, Xu K, et al. The strategy of non-intubated spontaneous ventilation anesthesia for upper tracheal surgery: A retrospective case series study. Transl Lung Cancer Res, 2022, 11(5): 880-889.
28. Sagan D, Sak J, Wiechetek M, et al. Differences in psychological perception of lung cancer between patients, medical staff and medical students. Eur J Cardiothorac Surg, 2012, 41(3): 607-611.
29. Clunie GM, Roe JWG, Alexander C, et al. Voice and swallowing outcomes following airway reconstruction in adults: A systematic review. Laryngoscope, 2021, 131(1): 146-157.
30. Clunie GM, Kinshuck AJ, Sandhu GS, et al. Voice and swallowing outcomes for adults undergoing reconstructive surgery for laryngotracheal stenosis. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(3): 195-199.
31. Bibas BJ, Guerreiro Cardoso PF, Minamoto H, et al. Surgical management of benign acquired tracheoesophageal fistulas: A ten-year experience. Ann Thorac Surg, 2016, 102(4): 1081-1087.
32. Tazuke Y, Okuyama H, Uehara S, et al. Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction. J Pediatr Surg, 2015, 50(12): 2009-2011.
33. Timman ST, Schoemaker C, Li WWL, et al. Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis. Ann Cardiothorac Surg, 2018, 7(2): 227-236.
34. Lennon CJ, Gelbard A, Bartow C, et al. Dysphagia following airway reconstruction in adults. JAMA Otolaryngol Head Neck Surg, 2016, 142(1): 20-24.
35. Tayfun MA, Eren E, Başoğlu MS, et al. Postintubation laryngotracheal stenosis: Assessing the success of surgery. J Craniofac Surg, 2013, 24(5): 1716-1719.
36. Lui CG, Bensoussan Y, Pei M, et al. Factors associated with dysphagia in patients undergoing tracheal resection. JAMA Otolaryngol Head Neck Surg, 2023, 149(6): 505-511.
37. Rahimi N, Roesner I, Schweiger T, et al. Functional evaluation before and after laryngo-tracheal resection. Transl Cancer Res, 2020, 9(3): 2142-2148.
38. Nauta A, Mitilian D, Hanna A, et al. Long-term results and functional outcomes after surgical repair of benign laryngotracheal stenosis. Ann Thorac Surg, 2021, 111(6): 1834-1841.
39. Sihag S, Wright CD. Prevention and management of complications following tracheal resection. Thorac Surg Clin, 2015, 25(4): 499-508.
40. Cardoso PFG, Bibas BJ, Minamoto H, et al. Prophylaxis and treatment of complications after tracheal resection. Thorac Surg Clin, 2018, 28(2): 227-241.
41. Tapias LF, Mathisen DJ. Prevention and management of complications following tracheal resections-lessons learned at the Massachusetts General Hospital. Ann Cardiothorac Surg, 2018, 7(2): 237-243.
42. Stock C, Gukasyan N, Muniappan A, et al. Hyperbaric oxygen therapy for the treatment of anastomotic complications after tracheal resection and reconstruction. J Thorac Cardiovasc Surg, 2014, 147(3): 1030-1035.
43. Konen E, Yellin A, Greenberg I, et al. Complications of tracheal and thoracic surgery: The role of multisection helical CT and computerized reformations. Clin Radiol, 2003, 58(5): 341-350.
44. Heyer CM, Nuesslein TG, Jung D, et al. Tracheobronchial anomalies and stenoses: Detection with low-dose multidetector CT with virtual tracheobronchoscopy—Comparison with flexible tracheobronchoscopy. Radiology, 2007, 242(2): 542-549.
45. Wang R, Gonzalez-Rivas D, Wang C, et al. Non-intubated uniportal robotic-assisted thoracic surgery: the future of thoracic surgery? Ann Cardiothorac Surg, 2023, 12(1): 49-51.
46. Lee HY, Lee JW. Current status and future outlook of additive manufacturing technologies for the reconstruction of the trachea. J Funct Biomater, 2023, 14(4): 196.
47. Sun Y, Huo Y, Ran X, et al. Instant trachea reconstruction using 3D-bioprinted C-shape biomimetic trachea based on tissue-specific matrix hydrogels. Bioact Mater, 2023, 32: 52-65.
48. Crowley C, Birchall M, Seifalian AM. Trachea transplantation: From laboratory to patient. J Tissue Eng Regen Med, 2015, 9(4): 357-367.
49. Sun F, Lu Y, Wang Z, et al. Directly construct microvascularization of tissue engineering trachea in orthotopic transplantation. Mater Sci Eng C Mater Biol Appl, 2021, 128: 112201.
50. Kuss MA, Wu S, Wang Y, et al. Prevascularization of 3D printed bone scaffolds by bioactive hydrogels and cell co-culture. J Biomed Mater Res B Appl Biomater, 2018, 106(5): 1788-1798.

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