Abstract
Objective
Tracheobronchial adenoid cystic carcinoma is a rare, slow-growing malignancy with
a considerable propensity for local extension that may require complex airway resection
to achieve tumor-free margins. The objective of this study was to assess whether our
experience supports complex airway resection for tracheobronchial adenoid cystic carcinoma.
Methods
Consecutive patients who underwent curative resection for tracheobronchial adenoid
cystic carcinoma at our institution between 1970 and 2019 were included retrospectively
and classified as having had complex or standard resection. Complex surgery included
total tracheal replacement, associated esophageal resection, pneumonectomy, total
laryngectomy with tracheal resection, and carinal resection. Standard surgery included
tracheal resection, bronchoplastic resection, lobectomy, and bilobectomy. We obtained
data from medical records, referring physicians, patients, relatives, and public death
records.
Results
Of 59 included patients, 38 had complex and 21 had standard surgery. All 4 (6.8%)
patients who died postoperatively had undergone complex surgery. Postoperative morbidity
was 32.2% overall and was significantly higher after complex surgery (P = .043). Overall 5- and 10-year survival rates were 81.5% and 60.2%, with no significant
differences between groups (P = .31). By univariate analysis, T4 tumor and microscopically detectable tumor in
the operative specimen margins and gross tumor in the operative specimen margins were
associated with poorer survival (P < .05). In the subgroup with microscopically detectable tumor resection, survival
was significantly better with adjuvant radiotherapy (P < .05).
Conclusions
Complex resection for extended tracheobronchial adenoid cystic carcinoma may achieve
local control and satisfying long-term survival. However, this demanding procedure
is associated with high postoperative morbidity and mortality rates. Because adjuvant
radiotherapy improved outcomes after resection resulting in microscopically detectable
tumor in the operative specimen margins, expected outcomes after resection with no
detectable tumor in the margins must be compared to those after resection resulting
in microscopically detectable tumor in the margins plus radiotherapy, according to
the operative risk.
Video Abstract
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Graphical Abstract
Key Words
Abbreviations and Acronyms:
ACC (adenoid cystic carcinoma), R0 resection (no microscopically detectable tumor in the operative specimen margins), R1 (microscopically detectable tumor in the operative specimen margins), R2 (gross tumor in the operative specimen margins), TBACC (tracheobronchial adenoid cystic carcinoma)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 07, 2022
Accepted:
October 18,
2022
Received in revised form:
September 15,
2022
Received:
April 13,
2022
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
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- Commentary: Complexity in rare disease: A look at surgical outcomes in tracheobronchial adenoid cystic carcinomaThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 6
- PreviewTracheobronchial adenoid cystic carcinoma (TBACC) typically affects relatively young, healthy adults. Because of its indolent nature, patients may present with more advanced disease. The treatment goal is en bloc resection without evidence of microscopic disease at the margins (R0), but this can be difficult to achieve because of the size of tumor and the need for tension-free reconstruction of the airway. TBACC is radiosensitive, and a debate persists regarding the radicality of resection that would result in an R0 resection versus lesser resection to microscopic positive margin(s) (R1) followed by adjuvant radiation.
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