title: Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina.
abstract: BACKGROUND
  Tracheal resection for primary carcinoma may extend survival. We evaluated survival after surgical resection or palliative therapy to identify prognostic factors.
  
  
  METHODS
  We conducted a retrospective study of patients diagnosed with primary adenoid cystic carcinoma (ACC) or squamous cell carcinoma (SCC) of the trachea between 1962 and 2002. Laryngotracheal, tracheal, or carinal resection was performed when distant metastasis and invasion of adjacent mediastinal structures were absent and tumor length permitted. Radiotherapy was administered after operation (54 Gy), except in superficial tumors, or as palliation (60 Gy).
  
  
  RESULTS
  Of 270 patients with ACC or SCC (135 each), 191 (71%) were resected. Seventy-nine were not resected due to tumor length (67%), regional extent (24%), distant metastasis (7%), or other reasons (2%). Overall operative mortality was 7.3% (14/191) and improved each decade from 21% to 3%. Tumor in airway margins was present in 40% (17/191) of resected patients (ACC 59% versus SCC 18%) and lymph node metastasis in 19.4% (37/191). Overall 5- and 10-year survival in resected ACC was 52% and 29% (unresectable 33% and 10%) and in resected SCC 39% and 18% (unresectable 7.3% and 4.9%). Multivariate analysis of long-term survival found statistically significant associations with complete resection (p < 0.05), negative airway margins (p < 0.05), and adenoid cystic histology (p < 0.001), but not with tumor length, lymph node status, or type of resection.
  
  
  CONCLUSIONS
  Locoregional, not distant, disease determines resectability in primary tracheal carcinoma. Resection of trachea or carina is associated with long-term survival superior to palliative therapy, particularly for patients with complete resection, negative airway margins, and ACC.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. hgaissert@partners.org
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.forename: Hermes C
authors.initials: HC
authors.lastname: Grillo
authors.forename: M Behgam
authors.initials: MB
authors.lastname: Shadmehr
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: Manjusha
authors.initials: M
authors.lastname: Gokhale
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007830:Larynx / Q000601:surgery; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D016019:Survival Analysis; D017741:Survivors; D014132:Trachea / Q000601:surgery; D014134:Tracheal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome