Tracheal autotransplantation as a new and reliable technique for the functional treatment of advanced laryngeal cancer.
OBJECTIVE
Tracheal autotransplantation allows for reconstruction of extended hemilaryngectomy defects (including half of the cricoid cartilage) after resection of laryngeal or hypopharyngeal cancer. A series of 38 patients underwent the operation. The technique involved a two-stage procedure (stage 1, tracheal revascularization; stage 2, hemilaryngectomy and tracheal autotransplantation) because the trachea requires at least 2 weeks for revascularization. The objective was to improve the oncological reliability of the procedure by performing a one-stage tumor resection.


METHODS
Five patients who underwent a one-stage tumor resection are presented. They had T2 (n = 3) to T3 (n = 2) N0 laryngeal tumors.


METHODS
Neck dissection, tumor resection, and tracheal revascularization were all performed during the first operation. The radial forearm fascia flap was designed with a distal fascial paddle and a proximal skin paddle. A 4-cm segment of cervical trachea was wrapped with the fascial paddle for revascularization, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction consisted of tracheal autotransplantation and was performed 4 months after the first procedure. Medical records were reviewed to determine time to oral intake, time to decannulation, length of hospital stay, and postoperative complications.


RESULTS
After the first operation the skin paddle of the radial forearm flap succeeded in a restoration of the sphincteric function. The mean time to oral intake for solids was 9.0 days (SD = 2.6 d) and the mean length of hospital stay was 11.2 days (SD = 2.2 d). All patients were able to speak with the tracheal cannula in place. All laryngeal functions were restored after the second operation. The mean time to oral intake for solids was 8.2 days (SD = 5.2 d). The mean time to oral intake for liquids was 16.6 days (SD = 6.3 d), and the mean length of hospital stay was 9.6 days (SD = 2.3 d). The mean time to closure of the tracheostomy and removal of the gastric tube was 27.0 days (SD = 5.8 d).


CONCLUSIONS
Tracheal autotransplantation allows for a functional treatment of advanced laryngeal cancers and is compatible with a one-stage tumor resection.
Delaere
Pierre R
PR
Department of Otolaryngology-Head & Neck Surgery, University Hospital St. Rafael, Catholic University of Leuven, Kapucijnenvoer 33, B-3000 Leuven, Belgium. pierre.delaere@uz.kuleuven.ac.be
Hermans
Robert
R
D000368:Aged; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D013524:Surgical Flaps; D014132:Trachea / Q000637:transplantation*; D014182:Transplantation, Autologous