Effect of mitomycin in the surgical treatment of tracheal stenosis.

Abstract

OBJECTIVE:

To assess the capacity of high and low doses of the antimitotic drug mitomycin to prevent laryngeal stenosis in an animal model.

METHODS:

A prospective, randomized, double-blind, controlled study was carried out. End-to-end anastomosis was performed in 18 rabbits after tracheal annulus resection to produce inflammation. There were 3 treatment groups: topical saline (isotonic sodium chloride solution) and low-dose (0.2 mg/mL) and high-dose (0.5 mg/mL) topical mitomycin.

RESULTS:

A total of 107 procedures were performed: 54 surgical procedures, 35 fibrobronchoscopies, and 18 biopsies. The effect of mitomycin was dose related. In the high-dose mitomycin group, most rabbits progressed to stenosis with a percentage decrease in airway diameter that was significantly greater than in the other 2 groups (P <.001). The mean (SD) percentage of maximum stenosis in the high-dose group was 51% (22%). In the low-dose and saline groups, it was 18% (13%) and 16% (9%), respectively. No significant differences in tracheal stenosis between the low-dose mitomycin and saline groups were observed. Blinded histopathological analysis also showed no significant differences between the saline group and the low-dose mitomycin group. Compared with the other 2 groups, the high-dose mitomycin group had a significant increase in fibroproliferative tissue (P <.001).

CONCLUSION:

These results suggest that topical mitomycin is not effective for avoiding tracheal stenosis and may provoke the opposite effect if the dose is not carefully selected.

• Authors: Rodrigo Iñiguez-Cuadra, José San Martín Prieto, Magaly Iñiguez-Cuadra, Sergio Zúñiga Erranz, David Jofré Pavez, Sergio González Bombardiere, J M Guilemany Toste, Rodrigo Iñiguez-Sasso
• Journal: Archives of otolaryngology--head & neck surgery (Arch Otolaryngol Head Neck Surg) Vol. 134 Issue 7 Pg. 709-14 (Jul 2008) ISSN: 1538-361X [Electronic] United States
• PMID: 18645119 (Publication Type: Journal Article)

Chemical References

• Antimitotic Agents
• Mitomycin

Topics

• Airway Obstruction (pathology, prevention & control)
• Anastomosis, Surgical
• Animals
• Antimitotic Agents (pharmacology)
• Biopsy
• Bronchoscopy
• Disease Models, Animal
• Dose-Response Relationship, Drug
• Laryngoscopy
• Laryngostenosis (pathology, prevention & control)
• Larynx (pathology, surgery)
• Mitomycin (pharmacology)
• Postoperative Complications (pathology, prevention & control)
• Prospective Studies
• Rabbits
• Trachea (pathology, surgery)
• Tracheal Stenosis (pathology, prevention & control)