Primary major airway tumors; management and results

Objective: Primary major airway tumors are rare. A retrospective analysis of referral centers experience could be helpful for their management. Methods: Fifty-one patients, including 44 (86%) malignant and seven (14%) benign with primary tumors of subglottis, trachea, carina, and main stem bronchi, were managed in a 14-year period. Based on computed tomography (CT) scan and rigid bronchoscopy findings, those who evaluated as resectable underwent airway resection and reconstruction. The others were managed by one or a combination of these methods: core out, laser, chemotherapy, radiotherapy, and tracheostomy. Follow-up was completed in 88.2%, mean (35.2 33.2 months). Results: Extraluminal extension of the tumor found in CTscan was significantly associated with unresectability (p = 0.006). Thirty-two patients underwent resection with three complications (9%) and one mortality (3%). Nineteen were managed by non-resectional methods; of these, 15 were found unresectable, because of tumor length, extensive local invasion or diffuse distant metastases, and four due to risk—benefit ratio or patient preference. Among 18 patients with adenoid cystic carcinoma 13 (72%) were resected (seven with negative margins). Overall 1-, 2-, 5-, and 8-yearsurvival was90.9%, 90.9%, 77.9%, and 19.5%, respectively. In unresectable tumorswith adenoidcystic carcinoma,overall 1- and 2-year survival was 60% and 40%, respectively. Data analysis found significant association of long-term survival with resection (p = 0.005) but not with negative margins in adenoid cystic carcinoma. Among 15 patients with carcinoid tumors, all were alive at the end of follow-up, except one who died after surgery.Conclusions:Airway resection,if feasible, may extend survival and may even be curative, with low morbidity and mortality, in most patients with major airway tumors. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.