Surgical and functional outcomes following resection of benign laryngotracheal stenosis.
A. Hanna*a (Dr), A. Nautab (Dr), D. Mitilianb (Dr), A. Crutua (Dr), O. Mercierb (Prof), E. Fadelb (Prof)
a Interventional bronchoscopy unit, Department of Pulmonary medicine and Lung Transplantation, Marie Lannelongue Hospital., Le Plessis Robinson, FRANCE ; b Department of Thoracic, Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital., Le Plessis Robinson, FRANCE
We evaluated all patients operated for BSLTS, between January 2007 and November 2018. Post-operative assessment was conducted by flexible bronchoscopy at day 1 and 7, clinical and endoscopic evaluation at 1 month, and if necessary at 3 and 6 months. We analyzed 30-day mortality, overall complications and success rates. Late surgical outcomes included restenosis and mortality. Functional outcomes and quality of life were assessed by questionnaires (Visual Analogic Scale (VAS), modified Medical Research Council for dyspnea, VAS for swallowing, Voice Handicap index (VHI)).
Of the 194 patients who underwent tracheal surgery, 43 were operated for benign laryngotracheal stenosis: 28 with a “modified Pearson technique” and 15 with “Grillo’s intervention”. A laryngeal release was performed in 15 cases (32%). Thirty-day death, overall complications and success rates were 0%, 44%, and 95%, respectively. Late surgical outcome data (mean follow-up 53 months) were available for 38 patients (88%). There were 7 (18%) restenoses and 36 (95%) late surgical successes. Thirty-four patients (79%) responded to functional questionnaires. There was a significant diminution of mean postoperative dyspnea VAS scores during rest (-5.4 (±4.2)) and activity (-5.6 (±4.8)) (p<0.001), a trend toward decreased mMRC grade after surgery (p=0.057) (65% postoperative grade 0). According to VHI scores, 30 patients (88%) had no to moderate voice impairment and 4 (12%) experienced severe impairment. Finally, 85% of patients (n=29) felt an improvement in their quality of life. Improved quality of life was significantly associated with: lower post-operative dyspnea VAS score during rest (p<0.01) and exercise (p<0.01); lower mMRC grade (p=0.012) and lower VHI score (p=0.01).
In the management of BSLTS, laryngotracheal resection with primary end-to-end anastomosis is safe and provides excellent surgical and functional outcomes leading to improvement in quality of life. It should be considered as the best curative treatment for BSLTS.
Disclosure of funding source(s): none