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 and Oncology, 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 high-difficulty, high-complexity, and high-risk surgeries such as tracheal resection and reconstruction, the management of the anastomosis directly impacts the surgical outcomes and long-term quality of life for patients. However, there is currently a lack of comprehensive literature addressing this topic in the perioperative period. This article reviews the theoretical foundations both domestically and internationally, combined with the long-term practical experience from our center, aiming to provide a more complete strategy for anastomosis management in the perioperative period of tracheal reconstruction surgery.

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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