Surgical treatment of tracheal stenosis during Covid-19 era: a single-center experience and lessons learnt on the field.
Covid-19
SARS-CoV2 pandemic
Tracheal stenosis
Tracheal surgery
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
20
06
2023
accepted:
26
06
2023
medline:
18
8
2023
pubmed:
17
7
2023
entrez:
17
7
2023
Statut:
ppublish
Résumé
SARS-CoV2 outbreak led to several healthcare system challenges, especially concerning respiratory support to Covid-19 patients. In the first 2 years of pandemic (2020-2021), we assisted to a marked increase of post-invasive mechanical ventilation (IMV) tracheal stenosis incidence, many of them requiring surgical treatment, namely resection and primary end-to-end anastomosis. Our aim is to describe our experience during the abovementioned biennium, focusing on postoperative outcomes of patients who have had Covid-19 ("post-Covid"). We retrospectively collected pre-, intra- and postoperative data on all patients who underwent tracheal surgery for benign stenosis in our Unit from May 2020 to October 2021, including previous Covid-19. Comparison between "post-Covid-19" and "non-Covid-19" groups' outcomes was then performed. Patients were 9 males and 6 females, and mean age was 57.4 ± 13.21 years. Nine patients had previous Covid-19 (60%). All patients underwent multidisciplinary preoperative evaluation. Almost every operation was conducted by cervicotomy, and the mean length of the resected specimen was 23.9 ± 6.5 mm. Postoperative complications were: dysphonia (3 cases), wound infection (1), bleeding (1), ab-ingestis pneumonia (1), anastomosis dehiscence (2), and stenosis recurrence (1). Thirty-day mortality rate was 6.7% (1 patient). No significant differences between "post-Covid-19" and "non-Covid-19" groups were identified. Pathology revealed, in 5 "post-Covid-19" patients, signs of vasculitis or perivascular inflammatory infiltrate. Tracheal stenosis' surgical treatment has always been known as a challenging procedure because of high perioperative morbidity and mortality rates. Our experience shows that previous Covid-19 and ongoing pandemic did not significantly affect perioperative outcomes of patients who underwent tracheal resection and primary end-to-end anastomosis in a high-volume Center and after multidisciplinary workup.
Identifiants
pubmed: 37458903
doi: 10.1007/s13304-023-01577-6
pii: 10.1007/s13304-023-01577-6
pmc: PMC10435409
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1681-1690Informations de copyright
© 2023. The Author(s).
Références
Colice GL, Stukel TA, Dain B (1989) Laryngeal complications of prolonged intubation. Chest 96:877–884
doi: 10.1378/chest.96.4.877
pubmed: 2791687
Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ (2000) Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg 123(4):495–500
doi: 10.1067/mhn.2000.105714
pubmed: 11020193
Zias N, Chroneou A, Tabba MK, Gonzalez AV, Gray AW, Lamb CR, Riker DR, Beamis JF Jr (2008) Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med 21(8):18
doi: 10.1186/1471-2466-8-18
Cooper JD, Grillo HC (1969) The evolution of tracheal injury due to ventilatory assistance through cuffed tubes: a pathologic study. Ann Surg 169(3):334–348
doi: 10.1097/00000658-196903000-00007
pubmed: 5266019
pmcid: 1387433
Patterson GA, Campbell DB (2000) Clinical-pathologic conference in thoracic surgery: basaloid squamous carcinoma of the trachea. J Thorac Cardiovasc Surg 120:187–193. https://doi.org/10.1067/mtc.2000.107520
doi: 10.1067/mtc.2000.107520
pubmed: 10884673
Honings J, Gaissert HA, Ruangchira-Urai R, Wain JC, Wright CD, Mathisen DJ et al (2009) Pathologic characteristics of resected squamous cell carcinoma of the trachea: prognostic factors based on an analysis of 59 cases. Virchows Arch 455:423–429
doi: 10.1007/s00428-009-0843-6
pubmed: 19838727
pmcid: 2772963
Richards-Belle A, Orzechowska I, Gould DW, Thomas K, Doidge JC, Mouncey PR, Christian MD, Shankar-Hari M, Harrison DA, Rowan KM (2020) COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland. Intensive Care Med 46(11):2035–2047. https://doi.org/10.1007/s00134-020-06267-0 . (Epub 2020 Oct 9. Erratum in: Intensive Care Med. 2021 Jun;47(6):731-732. PMID: 33034689; PMCID: PMC7545019)
doi: 10.1007/s00134-020-06267-0
pubmed: 33034689
pmcid: 7545019
Piazza C, Filauro M, Dikkers FG, Nouraei SAR, Sandu K, Sittel C, Amin MR, Campos G, Eckel HE, Peretti G (2021) Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European laryngological society. Eur Arch Oto-Rhino-Laryngol 278(1):1
doi: 10.1007/s00405-020-06112-6
Fiacchini G, Tricò D, Ribechini A, Forfori F, Brogi E, Lucchi M, Berrettini S, Bertini P, Guarracino F, Bruschini L (2021) Evaluation of the incidence and potential mechanisms of tracheal complications in patients with COVID-19. JAMA Otolaryngol Head Neck Surg 147(1):70–76. https://doi.org/10.1001/jamaoto.2020.4148
doi: 10.1001/jamaoto.2020.4148
pubmed: 33211087
Mussi A, Ambrogi MC, Ribechini A, Lucchi M, Menoni F, Angeletti CA (2001) Acute major airway injuries: clinical features and management. Eur J Cardiothorac Surg 20(1):46–51 (Discussion 51-2)
doi: 10.1016/S1010-7940(01)00702-3
pubmed: 11423273
Karagiannidis C, Mostert C, Hentschker C, Voshaar T, Malzahn J, Schillinger G, Busse R (2020) Case characteristics, resource use, and outcomes of 10021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med 8(9):853–862
doi: 10.1016/S2213-2600(20)30316-7
pubmed: 32735842
pmcid: 7386882
Adil MT, Rahman R, Whitelaw D, Jain V, Al-Taan O, Rashid F, Munasinghe A, Jambulingam P (2021) SARS-CoV-2 and the pandemic of COVID-19. Postgrad Med J 97(1144):110–116
doi: 10.1136/postgradmedj-2020-138386
pubmed: 32788312
Hur K, Price CPE, Gray EL, Gulati RK, Maksimoski M, Racette SD, Schneider AL, Khanwalkar AR (2020) Factors associated with intubation and prolonged intubation in hospitalized patients with COVID-19. Otolaryngol Head Neck Surg 163(1):170–178
doi: 10.1177/0194599820929640
pubmed: 32423368
pmcid: 7240317
Milner A (2021) Tracheal resection following prolonged intubation in a COVID-19 patient. Southern Afr J Anaesthesia Analgesia 27(1):51–52
doi: 10.36303/SAJAA.2021.27.1.2495
Giordano D, Botti C, Castellucci A, Piro R, Ghidini A (2021) Tracheal stenosis after tracheotomy for COVID-19. Ear Nose Throat J 8:1455613211045539
Alturk A, Bara A, Darwish B (2021) Post-intubation tracheal stenosis after severe COVID-19 infection: a report of two cases. Ann Med Surg (Lond) 67:102468
pubmed: 34123379
Scholfield DW, Warner E, Ahmed J, Ghufoor K (2021) Subglottic and tracheal stenosis associated with coronavirus disease 2019. J Laryngol Otol 135(7):656–658
doi: 10.1017/S0022215121001134
pubmed: 33973511
Sandu K (2021) Laryngotracheal complications in intubated COVID-19 patients. Clin Med Insights Case Rep 14:11795476211020590
doi: 10.1177/11795476211020590
pubmed: 34104030
pmcid: 8165861
Tapias LF, Mathisen DJ (2018) Prevention and management of complications following tracheal resections-lessons learned at the Massachusetts General Hospital. Ann CardiothoracSurg 7(2):237–243
doi: 10.21037/acs.2018.01.20
Wright CD, Grillo HC, Wain JC, Wong DR, Donahue DM, Gaissert HA, Mathisen DJ (2004) Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg 128(5):731–739
doi: 10.1016/j.jtcvs.2004.07.005
pubmed: 15514601
Bibas BJ, Terra RM, Oliveira Junior AL, Tamagno MF, Minamoto H, Cardoso PF, Pêgo-Fernandes PM (2014) Predictors for postoperative complications after tracheal resection. Ann Thorac Surg 98(1):277–282
doi: 10.1016/j.athoracsur.2014.03.019
pubmed: 24820396
Piazza C, Del Bon F, Paderno A, Grazioli P, Mangili S, Lombardi D, Nicolai P, Peretti G (2014) Complications after tracheal and cricotracheal resection and anastomosis for inflammatory and neoplastic stenoses. Ann OtolRhinolLaryngol 123(11):798–804
Williams T, McGrath BA (2021) Tracheostomy for COVID-19: evolving best practice. Crit Care 25(1):316. https://doi.org/10.1186/s13054-021-03674-7 . (PMID: 34461964; PMCID: PMC8405347)
doi: 10.1186/s13054-021-03674-7
pubmed: 34461964
pmcid: 8405347
Lucchi M, Ambrogi M, Aprile V, Ribechini A, Fontanini G (2020) Laryngotracheal resection for a post-tracheotomy stenosis in a patient with coronavirus disease 2019 (COVID-19). JTCVS Tech 4:360–364
doi: 10.1016/j.xjtc.2020.08.023
pubmed: 32838338
pmcid: 7423512
Becker RC (2020) COVID-19-associated vasculitis and vasculopathy. J Thromb Thrombolysis 50(3):499–511. https://doi.org/10.1007/s11239-020-02230-4
doi: 10.1007/s11239-020-02230-4
pubmed: 32700024
pmcid: 7373848
Auchincloss HG, Wright CD (2016) Complications after tracheal resection and reconstruction: prevention and treatment. J Thorac Dis 8(Suppl 2):S160–S167
pubmed: 26981267
pmcid: 4775259