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Objective We describe the surgical technique and peroperative management of tracheal and carinal replacement with aortic allografts for large salivary gland–type carcinoma and report the results with a mean 34 months' follow-up. Methods We performed tracheal and carinal replacements with aortic allografts in 6 patients with extensive mucoepidermoid (n = 1) or adenoid cystic (n = 5) carcinomas. Tracheal tumor resection was followed by carinal restitution (n = 3) and interposition of the graft, splinted by a silicone stent. The allograft consisted of an aortic segment, either fresh (in the first 2 patients) or cryopreserved (in the last 4). All grafts were wrapped with bulky and well-vascularized flaps (pectoral muscle flap all patients, with an additional "thymopericardial fat flap" in the last 2) to promote revascularization and to prevent erosion of adjacent large vessels or fistulas. No immunosuppressive therapy was administered. Results Complete resection (R0) was achieved in 5 (83%) of 6 patients. Three of the first 4 patients experienced major morbidity, mainly fistulas between the esophagus and graft. The last 2 patients had an uneventful outcome. All grafts transformed into well-vascularized conduits focally lined with respiratory epithelium. So far, the last 4 patients are disease-free and 3 of them have returned to full-time employment. Stent removal has not been attempted in any patient. Conclusion Tracheal replacement with aortic allografts enables resection of extensive tumors with a curative intent. Efficient protective wrap around the graft is mandatory. Further follow-up is required to determine whether cartilage rings are generated within the graft, as in animal models.

Objective Although resection of giant bullae for the purpose of improving the function of underlying compressed lung is an accepted form of surgery for emphysema, there is only limited information regarding long-term improvement in dynamic hyperinflation and exercise tolerance. Our major goal was to investigate the effects of lung resection for giant bullae on pulmonary function, dynamic hyperinflation, and exercise capacity in patients with chronic obstructive pulmonary disease characterized by emphysema. Methods Pulmonary function and exercise testing were assessed prospectively before and 3, 6, 12, 24, and 48 months after surgery in 12 patients who had chronic obstructive pulmonary disease with emphysema who underwent lung resection of giant bullae. Results Forced expiratory volume, diffusing capacity for carbon monoxide, arterial partial pressure of oxygen, and exercise capacity were significantly increased after resection of surgical bullae. Dynamic hyperinflation, as assessed by reduction in inspiratory capacity and dyspnea Borg scale, were significantly decreased during exercise. Improvement in baseline and exercise functional capacity slightly decreased over time, remaining, however, far above the value before surgery. Conclusion Altogether, these findings suggest that surgery for resection of giant bullae is an effective procedure for improving airflow, limiting gas exchange, and limiting exercise dynamic hyperinflation over time.