title: Laryngotracheoplastic resection for primary tumors of the proximal airway.
abstract: BACKGROUND
  Primary tumors of the airway with proximity to vocal cords and recurrent laryngeal nerves can be resected with sparing of the larynx. Long-term data on survival and local recurrence after laryngotracheal resection are scarce.
  
  
  METHODS
  We conducted a retrospective study of laryngotracheal resection and reconstruction for primary tumors of the airway since 1972.
  
  
  RESULTS
  Twenty-five patients aged 15 to 77 years presented with adenoid cystic carcinomas (n = 9), squamous cell carcinomas (n = 6), and other airway tumors (n = 10). Subglottic resection consisted of anterior cricoid in 5 patients; posterior cricoid mucosa in 9 patients, with resection of the posterior cricoid plate in 3 patients; lateral resection in 7 patients; and combined anterior and posterior elements in 4 patients. Vascularized trachea was tailored to reconstruct the defect. Seven patients without hoarseness required resection of the recurrent laryngeal nerve, and 4 other patients with hoarseness did not. There were no operative deaths. Two (8.0%) patients who had received prior high-dose cervical radiation had anastomotic separation, one requiring laryngectomy. One patient needed permanent tracheostomy, and temporary (<2 months) airway tubes were used in 5 patients. Sixteen patients received postoperative radiation. Median follow-up was 101 months. Four (16%) patients died of disease. Overall survival at 5 and 10 years was 79% and 64%, respectively. No patient underwent laryngectomy for recurrence.
  
  
  CONCLUSIONS
  Laryngotracheal resection and immediate reconstruction for subglottic tumors is achieved with good preservation of voice, low morbidity, and no compromise of long-term survival.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Blake 1570, 55 Fruit Street, Boston, MA 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: Behgam M
authors.initials: BM
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000601:surgery; D018277:Carcinoma, Mucoepidermoid / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002813:Chondrosarcoma / Q000601:surgery; D003371:Cough / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology; D010146:Pain / Q000209:etiology; D012135:Respiratory Sounds / Q000209:etiology; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D016019:Survival Analysis; D014134:Tracheal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome