Tracheal resection and anastomosis in post-intubation tracheal stenosis: a systematic review

Abstract OBJECTIVES Surgical resection of the stenotic segment with end-to-end anastomosis is considered the gold standard in post-intubation tracheal stenosis. However, outcomes of this concrete etiology are not well described. With the aim to examine the extent, range, and characteristics of the existing evidence, a scoping review was performed. METHODS Data sources included MEDLINE, Scopus, Ovid, and the Cochrane databases. Inclusion criteria consisted of studies in adult patients with post-intubation tracheal stenosis that reported characteristics, surgical management and outcomes. RESULTS 125 articles were identified, of which 10 were included in the final analysis. All studies were case reports or case series (level 4 evidence) grouping 110 patients, 75 males and 35 females. The age ranged from 15 to 71 years. Cotton-Myer stenosis grade was 1 (1 [0.9%]), 2 (25 [22.7%]), 3 (70 [63.6%]), and 4 (14 [12.7%]). Stenosis location was in the tracheal upper-third in 108 (98.2%), the middle-third in 1 (0.9%), and the lower-third in 1 (0.9%). Stenosis length ranged from 1 to 5.6 cm. Follow-up ranged from 1 to 60 months (two years for the most). Most frequent complications were transitory dysphagia in 13 (11.3%), granuloma formation in 8 (7.3%), dehiscence or air leak in 5 (4.5%), and wound infection in 4 (3.6%). Restenosis rate ranged from 2% to 25%. There was no perioperative mortality. CONCLUSIONS Tracheal resection and primary anastomosis in post-intubation tracheal stenosis appear to be safe and effective in the short and mid-terms; however, the very low level of evidence found prevents definitive conclusions.