Surgical technique and results of tracheal and carinal replacement with aortic allografts for salivary gland–type carcinoma
Received 16 September 2009; received in revised form 21 December 2009; accepted 3 January 2010. published online 12 April 2010.
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.
dClinique des Maladies Respiratoires, CHU de Lille, France, Institut de Médecine Prédictive et de Recherche Thérapeutique, IFR 114, Faculté de Médecine, Université de Lille 2, Lille, France, and EA4319, University Nice Sophia Antipolis, Nice, France
Address for reprints: Alain Wurtz, MD, Pôle de Chirurgie Thoracique, Hôpital Albert Calmette, CHU Lille, F59037 Lille Cedex, France.
This work was supported by the Ministère de la Santé et des Sport, the Agence de la Biomedecine and the RESPIR foundation.
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