From 1963 to 1983, 44 patients presented with a primary
tracheal neoplasm that was amenable to surgical treatment. Forty-two of the 44
tumors were malignant. Thirty-three patients were managed by resection and primary anastomosis. The following resections were done: trachea only, 12; trachea plus carina, 13; trachea plus cricoid cartilage, four; and trachea plus larynx, four. There were two operative deaths in these 33 patients. Prosthetic reconstruction with heavy-duty
Marlex mesh was done in six patients. Three of the six died of erosion of the innominate artery during the postoperative period. In three patients with nonresectable
tumors, a
silicone-coated Montgomery T-tube provided transient but worthwhile palliation. In two patients with nonobstructive
adenoid cystic carcinoma involving the subglottis, irradiation was chosen as the initial treatment, since resection would necessitate
laryngectomy. Resection, including
laryngectomy, may be required in the future. The following points are emphasized: (1) A majority of operable
neoplasms can be resected through a cervical collar incision and
median sternotomy.
Median sternotomy is the optimal operative exposure in most
neoplasms necessitating resection of the carina. (2) Partial resection of the cricoid with sparing of the recurrent laryngeal nerves and larynx is possible in some patients with primary malignant
tumors involving the proximal trachea and subglottic region. (3) In patients with
adenoid cystic carcinoma, resection may afford excellent, long-term palliation even when the resection is incomplete. Pulmonary
metastases are common in patients with adenoid cystic
tumors. However, they usually progress slowly, may remain asymptomatic for many years, and are not necessarily a
contraindication to resection of the primary
tumor even when they are synchronous. Our experience suggests that adjunctive
radiotherapy is beneficial in patients with
adenoid cystic carcinoma.