Resection and Reconstruction of Trachea and Carina for Primary Adenoid Cystic Carcinoma

D. Galetta¹, L. Spaggiari^2
1European Institute of Oncology, Milan, Lombardia ²European Institute of Oncologgy, Milan, Lombardia

Please explain the educational or technical point that this video addresses.: Adenoid cystic carcinoma (ACC) is the second most common malignant tumor of the airway. Complete surgical resection of tracheal or carinal ACC remains the treatment of choice and is associated with long survival. This video illustrates the imaging studies and the surgical techniques adopted in 5 different tumor locations.

Please provide a 250 word summary of the surgical video being submitted.: First two patients: upper and lower tracheal ACC; they underwent en bloc tracheal resection followed by end-to-end tracheal anastomosis through a cervico-sternal and posterolateral thoracotomy, respectively. Third case: ACC of left tracheo-bronchial angle; reverse Barclay carinal resection through a trans-sternal, trans-pericardial approach was accomplished. Fourth patient: ACC involving right tracheo-bronchial angle and carina; lateral wall of trachea and carina were resected; the main right bronchus was shaped as a “flute-beack” and anastomized to trachea and main left bronchus. Fifth: ACC involving the lower left tracheal wall and main right bronchus with the carina was removed by right tracheal sleeve pneumonectomy.

Results:
On 49 carinal resections performed for airway neoplasms, 5 (10.2%) were for ACC. Nor operative neither major postoperative complication occurred and all patients obtained an excellent surgical result, survival, and disease-free survival ranging from 1 to 75 months. Only one patient had regional nodal involvement by tumor. Postoperative radiotherapy (PR) was administered in 2 patients who presented microscopic R1 disease.

Conclusions:
ACC of the trachea and carina has a good long-term prognosis if treated by surgical resection. Surgical technique must be individualized according with tumor location. Patients with tumor infiltration of the surgical margins should receive PR.