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Objective: In addition to use of a laser, argon plasma coagulation, electrocautery, or coring with a rigid bronchoscope, tumor debulking with a flexible cryoprobe is used for therapeutic bronchoscopy with an immediate effect for endobronchial pathologies. We performed this analysis to determine the usefulness, efficacy, and safety of the flexible cryorecanalization in a large population under routine conditions., Methods: We identified 225 bronchoscopic interventions that were done as cryorecanalization with a flexible cryoprobe. All patients had symptomatic airway stenosis. We determined the endoscopic success rate and safety (bleeding and perforation) of the procedure., Results: Successful cryorecanalization was achieved in 205 (91.1%) of 225 patients. The flexible cryoprobe was used with all patients, in most patients in combination with flexible bronchoscopy and only in a minority (n = 31, 13.8%) in combination with a rigid bronchoscope. Additional interventional techniques used were endobronchial stents (n = 11, 4.9%) and argon plasma coagulation (n = 37, 16.4%). Mild bleeding (if ice-cold NaCl or epinephrine solution was necessary) occurred in 9 (4.0%) patients, moderate bleeding (if argon plasma coagulation or a bronchus blocker was required) occurred in 18 (8.0%) patients, and severe bleeding (events with hemodynamic instability) never occurred., Conclusions: Cryorecanalization with the flexible cryoprobe for treatment of symptomatic endobronchial tumor stenosis is a safe technique with a high success rate and immediate treatment effect., (Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Background: Primary tumors of the airway with proximity to vocal cords and recurrent laryngeal nerves can be resected with sparing of the larynx. Long-term data on survival and local recurrence after laryngotracheal resection are scarce., Methods: We conducted a retrospective study of laryngotracheal resection and reconstruction for primary tumors of the airway since 1972., Results: Twenty-five patients aged 15 to 77 years presented with adenoid cystic carcinomas (n = 9), squamous cell carcinomas (n = 6), and other airway tumors (n = 10). Subglottic resection consisted of anterior cricoid in 5 patients; posterior cricoid mucosa in 9 patients, with resection of the posterior cricoid plate in 3 patients; lateral resection in 7 patients; and combined anterior and posterior elements in 4 patients. Vascularized trachea was tailored to reconstruct the defect. Seven patients without hoarseness required resection of the recurrent laryngeal nerve, and 4 other patients with hoarseness did not. There were no operative deaths. Two (8.0%) patients who had received prior high-dose cervical radiation had anastomotic separation, one requiring laryngectomy. One patient needed permanent tracheostomy, and temporary (<2 months) airway tubes were used in 5 patients. Sixteen patients received postoperative radiation. Median follow-up was 101 months. Four (16%) patients died of disease. Overall survival at 5 and 10 years was 79% and 64%, respectively. No patient underwent laryngectomy for recurrence., Conclusion: Laryngotracheal resection and immediate reconstruction for subglottic tumors is achieved with good preservation of voice, low morbidity, and no compromise of long-term survival.

A method is presented for the endoscopic intubation of malignant tumors of the trachea and main bronchi with a Souttar tube. This is appropriate when urgent relief of respiratory obstruction is necessary and when the tumor is unsuitable for resection. Eight patients have been so treated, with relief of symptoms for up to 70 weeks in seven. The method failed in one patient. There were no operative deaths.

A 67-year-old Japanese man with exertional dyspnea was found by laminagraphy to have tracheal obstruction. The stricture was localized at the cervical and mediastinal trachea and was 5.0 cm long on an x-ray film. Eight tracheal rings were successfully resected and the ends of the trachea were anastomosed. The lumen of the removed trachea was narrowed by intramural and intraluminal polypoid growth originating from the tracheal wall. Histologically, the tumor was diagnosed as a mixed type of malignant lymphoma. The patient had serum hepatitis postoperatively, but now he is living normally without any difficulty in respiration. No signs of recurrence have been seen in the 5 years, 4 months since the operation. From this experience, the rarity and the possibility of curative operation of this tumor are discussed.

Between 1962 and 1982, 416 primary tracheal reconstructions and 21 staged reconstructions were performed. Since then 80 additional tracheal reconstructions have been accomplished (to April of 1985). The first 20 years of our experience (1962 to 1982) have been scrutinized to identify complications and describe their management in patients operated on for tumors or postintubation lesions only. Because the series includes all cases, commencing in 1962 when tracheal surgery was not well developed, many complications reflect a learning experience. The first and second halves of the series have therefore been compared. Measures to prevent complications are discussed.