Definition & Overview
The excision of tracheal tumour or carcinoma is a medical procedure used to remove a tumour on the trachea. It can be either cervical or thoracic. The procedure is necessary for patients who have been diagnosed with a malignant primary tumour in the trachea. It is also performed on patients with secondary tumours occurring from tumours of the surrounding structures, such as the thyroid, larynx, lungs, and the oesophagus. If the procedure is not performed, the tracheal tumour may cause severe airway obstruction and other serious complications.
Who Should Undergo and Expected Results
The procedure is performed on patients with tracheal tumours and primary neoplasms of the trachea. It is also beneficial for patients whose primary cancers of the thyroid, oesophagus, larynx, or lungs have metastasised towards the trachea.
The procedure plays a key role in the treatment of malignant tracheal tumours, which make up around 80% of all primary tracheal tumours. Up to 44.3% of these tumours are squamous cell carcinoma with adenoid cystic carcinoma coming in second with 16.3% of cases. Squamous cell carcinoma cancers are highly associated with smoking, while adenoid cystic carcinomas are not. The former is more common among men aged 50 and 70, while the latter puts men and women aged between 40 and 60 at equal risk. A carcinoid tumour, on the other hand, is a slow-growing mass that originates from the endocrine or nervous system; they can grow on any part of the body.
Tumours are staged depending on their severity and scope. They are first established as:
- Locally advanced
- Metastatic or advanced
The cause of a tracheal tumour is often not known. Unlike lung cancer, it does not seem to be related to smoking. Thus, treatment focuses on:
- Removal of the cancer
- Relieving symptoms
- Preventing potential complications
- Destroying all remaining cancer cells
The excision of the tumour is key to preventing or relieving the symptoms of the disease. For example, with the tumour gone, the patient will no longer suffer from airway obstruction. However, patients still have to undergo cancer therapy following the excision. Their options include chemotherapy and radiation therapy.
The success of a tracheal tumour or carcinoma excision is influenced by several factors, including the stage of cancer. If the cancer is caught early, the patient has good overall prognosis and survival potential. Unfortunately, tracheal tumours are sometimes difficult to detect and diagnose due to their vague symptoms. These symptoms include:
- Dry cough
- Hoarse voice
- Difficulty swallowing
- Recurrent chest infections
- Blood-tinged mucus
- Noisy breathing
Since many of these symptoms can be easily attributed to other possible causes, tracheal tumours are sometimes misdiagnosed. In some cases, patients only complain when their voices become hoarse, which indicates that the tumour has grown significantly and is already putting some pressure on the oesophagus.
How is the Procedure Performed?
The complete excision of a tumour is possible if it is caught early. The surgeon removes the tumour by cutting out the part of the trachea that is affected by cancer. The surgeon then joins the cut ends of the trachea together.
Ideally, doctors only remove a maximum of 2 cm so that the trachea can be easily reconstructed. However, if the lesion or tumour covers a long area, surgeons need to perform a lateral resection. They make sure to leave the widest possible bridge of tracheal tissue to keep the patient’s airways working properly.
The main difference among different techniques used to excise tracheal tumours lie in the location of the tumour. Tumours located in the upper third portion of the trachea can be approached with a standard collar incision. Meanwhile, tumours on the distal third portion can be easily removed through a thoracotomy. However, tumours in the middle to bottom part of the trachea may require a cervical incision.
After the excision of a tracheal tumour or carcinoma, patients are placed in intensive care for a few days. It is normal for them to have drainage tubes placed to remove extra fluid or blood that may build up in the surgical area. Patients are also typically placed in a neck brace to keep the head in a safe position and to avoid moving the trachea as it heals. The neck brace has to stay in place for up to a week.
After the procedure, patients can discuss further treatment options with their doctors.
Possible Risks and Complications
Patients who undergo the procedure are at risk of:
- Allergic reaction to anaesthesia
- Damage to nearby structures
- Formation of granulation tissue
- Restenosis of the trachea
- Anastomotic separation
- Wound infection
- Laryngeal oedema
The risk of suffering from the above complications depends on:
- Patient’s health
- Length of the resected part of the trachea
- Underlying medical conditions, such as diabetes
- The use of a tracheal appliance
- History of tracheal resection
It is also possible for the tracheal tumour to recur, especially if the tracheal resection was incomplete.
Doctors aim to eliminate the risks of the procedure through:
- Pre-operative planning
- Proper intraoperative technique
- Careful patient selection
- Early diagnosis
Good post-operative care
Auchincloss HG, Wright CD. “Complications after tracheal resection and reconstruction: prevention and treatment.” J Thorac Dis. 2016 Mar; 8(Suppl 2): S160-167. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775259/
Hoerbelt R, Padberg W. “Primary tracheal tumors of the neck and mediastinum: resection and reconstruction procedures.” Chirurg. 2011 Feb; 82(2): 125-133. http://www.ncbi.nlm.nih.gov/pubmed/21253678