The role of conservative management in congenital tracheal stenosis: an evidence-based long-term follow-up study.
OBJECTIVE
Surgery has been the management of choice for severe congenital tracheal stenosis (CTS). The role of conservative management of CTS however is not clear. The aim of this study is to characterize the natural history of CTS, review the radiologic evidence of tracheal growth, and evaluate the clinical outcome and selection criteria of conservative management of CTS.


METHODS
A retrospective study was carried out on 22 consecutive children with symptomatic CTS admitted into a single institution between 1982 and 2001. The patients were categorized into operation (n = 11) and observation (n = 11) groups. Six patients of the observation group were followed up with serial computed tomography scan. Their tracheal growth was compared with that of healthy children of the same age.


RESULTS
The mortality rates of observation and operation groups were 9% and 27%, respectively, although the latter group consisted of more severely affected patients. The pathologic categorization of the CTS influenced the survival rates (P = .046, chi2), with the long segment type having the worst prognosis (67%). Serial computed tomography scans of 6 conservatively managed patients revealed that all stenotic tracheas continued to grow (P = .039, 2-tailed paired Student's t test). Of the 6 stenotic tracheas, 5 grew at a faster-than-normal rate, and the stenotic tracheal diameters approached those of normal diameters by the age of 9 years.


CONCLUSIONS
The management of patients with symptomatic CTS should be individualized. A selected group of patients with CTS can be safely managed nonoperatively.
Cheng
Wei
W
Division of General Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada 5G 1X8.
Manson
David E
DE
Forte
Victor
V
Ein
Sigmund H
SH
MacLusky
Ian
I
Papsin
Blake C
BC
Hechter
Sloan
S
Kim
Peter C W
PC
D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D014132:Trachea / Q000254:growth & development; D014135:Tracheal Stenosis / Q000151:congenital / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome