Fully-circumferential tracheal replacement: when and how?

Extensive tracheal resections are mainly considered in the treatment of extended malignant lesions. These are respectively: (I) for proximal tumors, monobloc laryngotracheal resection followed by construction of an anterior mediastinal tracheostomy (associated, when appropriate, with trans-hiatal esophagectomy and esophageal substitution by gastroplasty or coloplasty) (1); (II) segmental resection of the trachea over 50% of its length in adults and over 30% in children; (III) carinal resection, isolated or associated with pneumonectomy, when a greater than 4 cm airway gap makes end-to-end anastomosis impossible. In the latter two situations, the use of a tracheal substitute for fully-circumferential tracheal replacement (FTR) is mandatory. Occasionally, the tracheal substitute may be useful to treat a large congenital/acquired benign stenosis or malacia, or a dehiscence after tracheal or cricotracheal resection reconstruction by primary anastomosis (2).