Perioperative outcomes of median sternotomy for intrathoracic tracheal malignancies: a 15-year retrospective analysis.

Background: Tracheal resection and reconstruction is a complex thoracic surgery procedure. Posterolateral thoracotomy (PLT) is the standard approach for intrathoracic tracheal resection; however, research on the median sternotomy (MST) approach is limited. This study evaluated the surgical outcomes of MST in treating intrathoracic tracheal malignancies.

Methods: A 15-year retrospective analysis of the data of patients with primary intrathoracic tracheal malignancies who underwent "trachea + carina" resection and reconstruction at a single center was conducted.

Results: A total of 62 patients were included in the analysis. Among the patients, 27 (43.55%) underwent tracheal resection only, while 35 (56.45%) underwent combined carinal and main bronchial resection. The mean length of the resected tracheal segment was 35.00±8.15 mm, and 13 (20.97%) patients had a resection length of at least 40 mm. Negative surgical margins were achieved in 33 patients (53.23%), unilateral positive margins in 15 patients (24.19%), and bilateral positive margins in 14 patients (22.58%). The logistic regression analysis identified adenoid cystic carcinoma (ACC) pathology and extraluminal tumor growth as independent risk factors for positive surgical margins. No postoperative sternotomy site infection case was observed, and postoperative pain was generally well tolerated. Complications requiring medical intervention occurred in 16 patients (25.8%), including excessive granulation tissue formation at the anastomosis in 14 patients (22.58%) and an anastomotic fistula in 2 patients (3.23%). Notably, no instances of recurrent laryngeal nerve injury were reported.

Conclusions: The MST approach offers several advantages in the management of tracheal tumors, including better exposure, blood supply preservation, and left recurrent laryngeal nerve protection. Thus, it should be the preferred approach for long-segment resection and reconstruction.