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General Thoracic Surgery > Tracheal Tumors > Flashcards

Tracheal Tumors Flashcards

1
Q

Most tracheal tumors are benign or malignant?

A

Malignant

(MC SCC and adenoid cyststic carcinoma)

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2
Q

MC primary malignant tracheal tumors

A
  • SCC
  • Adenoid cystic carcinoma
  • Less common tumors:
    • Carcioids
    • Bronchogenic carcinoma
    • Sarcoma
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3
Q

Demographics of SCC and adenoid cystic carcinoma of trachea

A
  • MC in men (both)
  • MC in smokers (both)
  • Adenoid cystic: earlier in life (40-50 years old)
  • SCC: older in life (60-70 years old)
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4
Q

SCC or Adenoid Cystic Carcinoma:

Invades LN and mediastinum

A

SCC

(Adenoid cystic metastasizes vis submucosa; less likely to spread to LN)

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5
Q

SCC or Adenoid Cystic Carcinoma:

Mestastasize vai submucoa

A

Adenoid cystic carcinoma

(SCC via LN)

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6
Q

MC tumors to metastasize to trachea

A
  • Laryngeal ca
  • Lung ca
  • Thyroid ca
  • Esophageal ca
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7
Q

MC presenting s/s of tracheal tumors

A

Slowly progressive obstructive respiratory sx (wheezing or stridor)

(often misdiagnosed as adult-onset asthma)

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8
Q

Diagnostic modalities utilized for tracheal tumors

A
  • CT
  • Bronchoscopy
    • Rigid bronchoscopy (ID tumor location and external compression, biopsy)
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9
Q

Important principle for biopsies of tracheal tumor

A

Biopsy proximal and distal to visualized tumor

(accurately map tumor tumor size and involvement)

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10
Q

During dissection of the trachea, how much of the trachea can be delivered into the neck with hyperextension

A

50% of the length

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11
Q

Location of the blood supply to the trachea

A

Lateral borders

(fusion of inferior thyroid, bronchial, and internal thoracic arteries)

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12
Q

Location of Right and Left recurrent laryngeal nerve in relation to trachea

A
  • Right: along upper to mid trachea
  • Left: along majority of the entire length of trachea
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13
Q

Indicatins for tracheal resection and reconstruction for tracheal tumors

A
  • Lack of metastatic disease
  • Ability to determine resectibility
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14
Q

Resectibility of tracheal tumors depends upon which factors:

A
  • Length of trachea required for resection
  • Extent of invasion into adjacent strucutres
  • Patients functional status
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15
Q

Maximum amount of trachea that is usually amenable to reconstruction

A

Up to 6 cm

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16
Q

Hallmark feature of a durable repair after tracheal resection

A

Tension-free anastomosis

17
Q

Options for surgical exposure of the trachea

A
  • Cervical collar incision (upper trachea, adequate for most resections)
  • T-extension (inclues upper sternotomy)
  • Right thoracotomy (lower trachea, carina)
18
Q

Excessive lateral longitudinal dissection of trachea should be avoided to prevent what

A

Tracheal devascularization

Inadvertant injury to RLNs

19
Q

5 Classic Release Maneuvers for tracheal resection (in preferred order)

A
  • Pretracheal dissection
  • Neck flexion to 30 degrees with chin to sternum stitch
  • Laryngeal release (“drop” the larynx, cricoid, trachea)
  • Inferior pulmonary ligament release
  • Hilar release (incision of right pericardium, mobilization of RPA and SPV)
20
Q

More advanced release maneuver utilized if 5 classic techniques fail

A

Transection of left main bronchus with re-implantation onto right main bronchus

21
Q

Most serious complication after tracheal resection and reconstruction

A

Anastomotic dehiscence

22
Q
A
23
Q

Presentation of anastomotic dehiscence after tracheal resection and reconstruction

A

Days to Weeks after surgery

  • Wound infection
  • SQ air
  • Voice change
  • Stridor
  • Airway obstruction
24
Q

TOC for tracheal anastomotic dehiscence

A
  • Tracheostomy (maintain open airway)
  • Drain infection
  • Control defect (tracheostomy tube or soft tissue/muscle flap)

(Delayed reopeation to repair)

25
Q

SCC or Adeonoid cystic carcinoma:

Better overall survival

A

Adenoid cystic carcinoma

26
Q

Other than histology, most important prognostic factor for tracheal tumors

A

Completness of resection

27
Q

Management approach for:

  • positive distal margin after resection
  • inability to completely resect tumor without undue tracheal tension
A

Adjuvant XRT

(better to leave anastomosis tension-free than to resect too much)

28
Q

Palliation options for unresectable tracheal tumors

A
  • Rigid bronchoscopy: dilation of strictures and coring out of tumors
  • Laser ablation
  • Tracheobronchial stents
29
Q

Characteristic of tracheobronchial stents

A
  • Efficacous in proximal airways (trachea or mainstem bronchi)
  • Prone to migration
  • Aggressive mucolytic required
30
Q

Role of adjuvant XRT for resected tracheal tumors

A
  • All resected SCC and adenoid cystsic tumors should receive adjuvant XRT (after anastomosis has healed)
31
Q

Treatment options for unresectable tracheal tumors

A

XRT + palliative procedure

(palliative procedures: rigid bronch with dilation/core, laser ablation, stent)

General Thoracic Surgery (36 decks)

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