PURPOSE: Laringotracheal resection (LR) is the best treatment option for benign stenosis and is usually performed in high volume centers(HVC)for tracheal pathology.The aim of this study was to evaluate the feasibility and safety of a tracheal surgery program performed by a team trained in tracheal surgery in hospitals without experience in this field(low volume centers-LVC). The results of LR for benign stenosis performed by the same surgeons in HVC and LVC’ s were compared.
METHODS: All patients with LR for benign stenosis performed by the authors from January 2000 to January 2008 were included.All the surgical centers were approved by national or provincial health department to perform this kind of surgeries.LVC Medical and Nurse staff were informed about the surgical procedure and systematic postoperative management.The demographics,lesion description, operating technique and surgical results were prospectively recorded for each group.Student’ s t-test was used for comparison between groups.
RESULTS: A total of 115 patients were included (males 85, females 30). Mean age was 35 years (15 to 70 years).Mean follow-up: 24 months (12 to 60 months). 82(71%) were operated in a HVC and 33 in 12 different LVC. Locations were different in both groups (p<0,0001): subglottic n = 43 (HVC:21;LVC:22), proximal and mid trachea n =68(HVC:59;LVC:9) and distal trachea n =4(HVC:2;LVC:2).There were no difference in Length of resection (mean: 3.47cm),complications (mean 15%)and results (Good and satisfactory 95%,failure rate 1,7% and mortality rate 1,7%);(p:n.s.).
CONCLUSION: Laringotracheal resection for benign stenosis performed by a specialized team in centers without experience in tracheal surgery was safe and feasible with 95% of good and satisfactory results.Although more complex lesions (subglottic) were treated in LVC than HVC there were no differences in surgical results.
CLINICAL IMPLICATIONS: According to this study, surgical team experience and systematic postoperative management proved to have good results in laryngotracheal resections for benign stenosis in centers without experience in this field. This results could support the development of tracheal surgery programs outside specialized hospitals to allow easiest access to this outstanding therapeutic option.
DISCLOSURE: Fernando Abdala, No Financial Disclosure Information; No Product/Research Disclosure Information