Primary tumors of the trachea: An analysis of 35 consecutive cases

From January 1972 to December 1995, thirty-five patients with primary tracheal tumors were treated at Veterans General Hospital, Taipei. Sixteen of these patients received surgical therapy, seventeen patients were managed with irradiation, chemotherapy or ND-YAG laser phototherapy and two patients had only supportive management (one adenoid cystic carcinoma and one adenocarcinoma). Histological examination revealed 16 squamous cell carcinomas, 2 adenocarcinomas, 1 carcinosarcoma, 8 adenoid cystic carcinomas, 3 mucoepidermoid carcinomas, 1 hamartoma, 3 papillomas and 1 leiomyoma. The operative procedures used were: 1) segmental resection of the trachea and primary reconstruction of the airway through collar incision in 5 patients, 2) T-incision (collar incision + median sternotomy) in 3 patients and 3) right thoracotomy in 8 patients. The operative mortality and morbidity rate were 12.5% (2/16) and 37.5% (6/16), respectively. Two causes of operative mortality were one sepsis and the other anastomotic leakage with hypoxia. The postoperative complications included two cases of pneumothorax, one case of anastomotic leakage, one case of sepsis, one case of wound infection and one ease of wound disruption. Eight patients (one squamous cell carcinoma, five adenoid cystic carcinomas and two mucoepidermoid carcinomas) are free of disease after surgical resection and post-operative irradiation therapy. The overall 5-year survival rate is 18.8% (3/16) for squamous cell carcinoma, 87.5% (7/8) for adenoid cystic carcinoma and 100% (3/3) for mucoepidermoid carcinoma, respectively. The results of this survey revealed that histological type was the major prognostic factor in patients with primary malignant tracheal tumors, and that surgical resection with post-operative radiotherapy played an important role for long-term survival.