Management of Tracheocarinal Obstructive Disease

From April 1994 to March 1998, we managed twenty-eight patients with tracheobronchial obstructive disease (27 cases of malignant disease and 1 benign stricture). Cylindrical resection of the trachea and end-to-end anastomosis were performed in 6 patients; resection of the membranous portion of the trachea and patch repair using the latissimus dorsi muscle in 1, and carinal resection and primary reconstruction in 9 (right pneumonectomy in 3, left pneumonectomy in 1, upper right lobectomy in 4). Twelve patients with unresectable disease underwent airway stenting. Four patients who underwent carinal resection and upper right lobectomy or pneumonectomy with a combined resection of the superior vena cava for lung cancer, died of myocardial infarction, respiratory failure, airway bleeding or brain edema within 30 days after the surgery. There was no anastomotic leakage or anastomotic stricture in any of the patients.After stenting, the dyspnea remarkably improved in 11 of the 12 patients with unresectable disease.