Near Carinal Tracheal Resection

Aims: Feasibility of surgery with non tension end to end anastomosis for near carinal tracheal resection and reconstruction with preoperative planning and surgical approach strategy.

Presentation of the Case: 55 year old male presented with central airway obstruction and haemoptysis requiring intubation. CT scan revealed a mass at the lower trachea and bronchoscopy revealed a mass which was 3 rings above the carina for which debulking was done. Tumour histopathology reported adenoid cystic carcinoma. A right posterolateral thoracotomy, near carinal tracheal resection and reconstruction, with wedge resection of the lower lobe lung lesion was done to clear the extra trachea along with the right lung lesion. Intrathoracic tracheal release manoeuvres was employed to obtain a non-tension end to end anastomosis. Patient was extubated post operatively and follow up bronchoscopy and CT scan surveillance showed no evidence of recurrence.

Discussion: Management principle of tracheal adenoid cystic carcinoma is surgery with a clear resection margin. Preoperative planning with CT scan imaging and bronchoscopy is important to determine the location, extent and invasion of the tumour both longitudinally and transversely. The feasibility of resection and extend of resection details will allow the necessary release manoeuvre and surgical approach needed before embarking on surgery. Cases which complete resection is not achievable, radiotherapy option is available; with chemotherapy for advanced palliative cases.

Conclusion: Successful near carinal tracheal resection and reconstruction requires careful preoperative planning with imaging modalities and bronchoscopy. Multidisciplinary team approach gives the best outcome managing such cases.