| BackgroundThis systematic review aims to assess the anatomy and physiology,epidemiology,pathology,symptomology,diagnostics and auxiliary examination,treatment,complications and prognosis of cervical tracheal space-occupying lesions.Thereby,Clinicians can improve recognition of tumors of the cervical trachea,namely:to avoid misdiagnosis and missed diagnosis,to consider appropriate resection and reconstruction methods,to avoid the occurrence of related complications,to improve the rate of diagnosis and cure and the prognosis.MethodsA total of 80 patients diagnosed cervical tracheal tumor and treated in the Department of Otorhinolaryngology,Qilu Hospital of Shandong University from November 2005 to December 2018 were concluded.We retrospectively reviewed all cases over a thirteen year period.The clinical data were obtained from hospital case records,including:gender,age,smoking history,Symptoms and onset characteristics,imaging and endoscopy data,surgical approach and reconstruction,anesthesia,complications,postoperative comprehensive treatment,follow-up,etc.ResultOf the 80 patients with cervical tracheal space-occupying lesions,62 were malignant(77.5%)and 18 were benign(22.5%).Of the 62 malignant tumors,31 were primary tumor and 31 were secondary tumor,Adenoid cystic carcinoma was the most common primary malignancy(64.5%,20/31),followed by squamous cell carcinoma(19.4%,6)./31),differentiated thyroid cancer is the most common secondary malignancy(71.0%,22/31).The ratio of male to female in squamous cell carcinoma is 1:1,and the remaining pathological types are more female than male.Among patients with different pathological types,less than 50%of those with a history of smoking.Among the 18 benign lesions,there were benign tumors and tumor-like lesions,as well as goiters with ectopic or protruding tracheal.Asthma and dyspnea are the most common symptoms when cervical tracheal space-occupying lesions occur.In the case of moderate to severe dyspnea,the tracheal lumen obstruction in the cervical segment often exceeds 50%.Hemoptysis has a certain significance for suggesting that DTC invade the trachea.Cervical tracheal lesions are easily misdiagnosed,and the rate of misdiagnosis in this group was 27.5%(22/80).In enhanced CT,benign lesions are mostly narrow-basal nodules.Malignant tumors generally infiltrate along the wall and thicken the wall,but the specificity is not high.The degree of enhancement of SCC is significantly higher than that of DTC and ACC.After surgery,68 patients completely retained the laryngeal function,including 30 cases(44.1%)with sleeve resection,16 cases(23.5%)with wedge resection,13 cases(19.1%)with anterior cervical skin fistula,and 9 cases(13.2%)with autologous tissue flap repair.The average tracheal defect length of 30 patients who underwent a sleeve resection was 2.53 cm.In the case of sleeve resection,the intraluminal lesions in the trachea were significantly larger than the other procedures.The length of tracheal defect in patients with tissue flap repair was significantly longer than other procedures.Compared with ACC and DTC,SCC has a higher rate of invasion of the thyroid gland and esophagus.Cases with more than 50%of tracheal obstruction tend to undergo tracheotomy under local anesthesia followed by general anesthesia induction.44 patients pull out tracheal cannulation at 0.3 to 2 months after surgery.The extubation rate was 64.7%(44/68),and the average extubation time was 5.53 months.The rate of extubation of the tracheal cannula with sleeve resection and wedge resection was higher than that of the anterior cervical skin and tissue flap repair.The main factors leading to the inability to extubate were scarring of the trachea and vocal cord fixation.IThis group of patients continued to follow up to date,18 cases died,of which 16 died of local recurrence and distant metastasis,1 case died of massive hemorrhage 1 month after surgery,and 1 died of myocardial infarction.Survival analysis showed that ACC prognosis was superior to DTC and SCC in major pathological types.The common recent complications are pulmonary infection(5/80)and subcutaneous fluid(3/80).Common long-term complications are intratracheal scar stenosis(6/80)and intratracheal granulation.The average time of 6 cases of scar stenosis was 13.3 months after operation,and 5 cases were after sleeve resection.ConclusionsMost of the cervical tracheal neoplasm are malignant,in which adenoid cystic carcinoma and secondary differentiated thyroid carcinoma are common.Smoking may not be the main cause of cervical tracheal malignancies.The clinical misdiagnosis rate is so high that clinicians should take it seriously.Enhanced CT and endoscopy are effective means of assistive examination.Surgery is the primary treatment,and beforehand,surgeons and anesthesiologists should fully evaluate the airway.Choosing a appropriate surgical procedure and repair method,combined with postoperative comprehensive treatment,can improve improve the quality of postoperative survival.During the operation,the complete resection of the tumor should be the first rule.As an exception,when the adenoid cystic carcinoma is involved in a long range,microscopically positive margins can be accepted for airway reconstruction.With postoperative radiotherapy,the ideal prognosis can still be obtained.But meanwhile,the clinicians should pay attention to the characteristics of the adenoid cystic carcinoma,which are the late relapse and metastasis. |
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