Long-term outcomes and predictors of recurrence after interventional bronchoscopic dilation for post-intubation tracheal stenosis: a 24-month cohort study

Background: Benign tracheal stenosis (BTS) is a challenging condition in interventional pulmonology, with recurrence remaining a major limitation of endoscopic treatment. We aimed to evaluate clinical outcomes and safety of endoscopic treatment for acquired BTS and to describe recurrence over 24 months of follow-up. Methods: We conducted a retrospective cohort study at a tertiary-care hospital, including adults with BTS who underwent endoscopic airway recanalization. The primary outcome was first stenosis recurrence within 24 months. Recurrence-free survival was estimated using the Kaplan–Meier method. Associations between clinical and anatomical characteristics and time to recurrence were evaluated using Cox proportional hazards models. Results: A total of 490 patients were included, with a mean age of 54.9 ± 11.7 years; 62.2% were male. COVID-19-associated orotracheal intubation was the etiology in 70.0% of cases. Stenosis was predominantly subglottic (41.8%) or located in the upper trachea (31.2%), and 56.9% were classified as complex stenoses. Myer–Cotton grade III stenosis was present in 58.0% of patients. The index endoscopic strategy consisted of cryotherapy plus dilation in 68.0% and electrocautery plus dilation in 32.0%. The most frequent adverse events were bronchospasm (8.4%), hypoxemia (7.8%), reintubation (6.9%), and vocal cord paresis or paralysis (6.3%). Recurrence increased progressively from 6.9% at 3 months to 15.3% at 6 months, 27.6% at 12 months, 34.9% at 18 months, and 41.6% at 24 months. Median time to first recurrence was 8.9 months (IQR, 3.9–15.3). Recurrence-free survival was 92.9% at 3 months, 84.9% at 6 months, 72.7% at 12 months, 65.5% at 18 months, and 59.4% at 24 months. Absence of malacia (p=0.009) and simple stenosis (p<0.001) were associated with higher recurrence-free survival. Among patients with recurrence, 16.7% required open surgery or tracheal resection, 11.3% required stent placement, and 8.8% underwent tracheostomy. Conclusions: In patients with ETB treated with endoscopic intervention, recurrence progressively increased during follow-up, reaching 41.6% at 24 months, with a recurrence-free survival of 59.4%. The presence of malacia and greater stenosis complexity were associated with lower recurrence-free survival.