• Korean Journal of Bronchoesophagology
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• v.8 no.1
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• pp.50-56
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• 2002

Advanced or recurrent thyroid cancer, and metastatic paratracheal lymph nodes may directly invade the trachea and lead to tracheal stenosis. In these cases the stenosis is not circumferential and it would be possible to reconstruct the trachea after partial resection of the stenotic trachea. We experienced five cases of tracheal reconstruction after partial resection of the tracheal wall in four Patients of advanced thyroid cancer, and in one Patient of malignant paratracheal lymphadenopathy.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.61-69
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• 1997

A total of 55 patients underwent surgical managements for postintubation tracheal stenosis from July 1975 through March 1997. All but 8 had received ventilatory assistance. The patients had S cuff lesions, 17 stoma lesions, 7 at both levels, 5 at subglottic lesions. Thirty two patients underwent the sleeve tracheal resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Twenty two patients received the Montgomery T-tube for relief of airway obstruction. Simple excision of granulation tissue was done in 7 patients. Rethi procedures(anterior division of cricoid cartilage, partial wedge resection of lower thyroid cartilage and T-tube molding) were performed in 2 subglottic stenosis patients. And the other subglottic patient was received permanent tracheal fenestration at 1975. The tracheoesophageal fistula patient was done sleeve tracheal resection and end-to-end anastomosis with interrupted double layer closure of esophageal fistula site. Cervical approach was used in 49 cases, cervicomediastinal in 13 cases and median stemotomy In 6 cases. Techniques for obtaining tension-free anastomosis included a cervical neck flexion(15-30$^{\circ}$) in all sleeve resection patients and laryngeal release in one. The length of resection was 1.5 to 5.0 on A total of 41 patients(74.5%) had good(24 patients) or satisfactory(17 patients) results. But in ten cases, the restenosis of anastomosis site which is the most common complication was developed Two of them underwent a second reconstruction and 8 patients required T-tube insertion for airway maintenance. Three patients(5.4%) died. The causes of death were tracheo-innominate artery fistula(2) and sudden obstruction of airway(1).

• Korean Journal of Head & Neck Oncology
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• v.37 no.1
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• pp.63-66
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• 2021

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial circumferential tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.792-799
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• 1985

Primary neoplasms of the trachea are rare, but are a very serious critical life-threatening disease. Nearly all the lesions of the trachea are presented as obstructive lesions. Bronchoscopic examination including chest C-T, tomogram and air tracheogram are essential for the further definition of these lesions. The need for removal of tracheal tumors whether complete or incomplete, is clear enough regardless of the histology of the tumor. We have experienced 9 cases from Jan. 1965 to June, 1985. One patient with tracheal hamartoma was cured with complete resection through rigid bronchoscopy and another patient with fibrous histiocytoma was treated with re-excision and laser evaporation through superior mediastinotomy due to recurrence, 1 year later. The remaining patients were treated with mass excision or segmental resection and end-to-end anastomosis through collar incision and superior mediastinal sternotomy. The remaining two patients were operated with and segmental resection and end-to-end anastomosis of trachea using partial cardiopulmonary bypass. The histologic diagnosis were adenoid cystic Ca[5], fibrous histiocytoma[1], mucoepidermoid Ca[1]. hamartoma[1], anaplastic Ca.[1]. Three patients were treated post-operatively with radiation; with adenoid cystic Ca.[2] and anaplastic Ca.[1]. Their post-operative courses were uneventful during the follow-up from 2 months to 7 years.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.328-331
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• 1995

A 42-year-old Marfan female had a chronic dissection of the descending aorta[Type B and the aneurysmal expansion of the descending aorta caused compression of the trachea resulting in respiratory distress which mimicked bronchial asthma. The patient has been successfully managed by resection and replacement of the aneurysm in the descending aorta. The operation could be done without the aid of the partial cardiopumonary bypass. As the patient had been prepared by unilateral axillo-bifemoral by-pass using prosthetic graft 8mm in diameter 10days prior to the main operation.

• Korean Journal of Bronchoesophagology
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• v.10 no.2
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• pp.17-21
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• 2004

Background Insertion of tracheal stent in the treatment of benign tracheal & bronchial disease has increased since the introduction of expandable metallic stent. Material & Methods : Between Jan, 1995 and Feb. 2004, eight patients who had benign tracheo-bronchial disease underwent insertion of expandable metallic tracheal stent. We retrospectively analyzed stent insertion indications, complications, and following the result. Results : Surgical indications were post-intubation tracheal stenosis (1 case), tracheal stenosis following tracheal surgery (2 cases), tracheo-esophageal fistula (2 cases), broncho-pleural fistula(1 case), left main bronchus stenosis following bronchoplasty (1 case), and left main bronchus stenosis due to mediastinal repositioning (1 case). Expandable metallic tracheal stent was inserted in five patients to resolve dyspnea caused by airway obstruction, and to prevent recurrent pneumonia in three patients. The complication developed in 6 patients $75\%$; 3 cases of distal stenosis due to growth of granulation tissue, and one case each of tearing of posterior membrane, aggravation of tracheo-esophageal fistula, and airway partial obstruction due to stent migration. The stent was removed in 5 patients and tracheal surgery (tracheal resection and end to end anastomosis with primary repair of esophagus, pericardial patch tracheo-bronchoplasty, tracheal repair and omental wrapping) was performed in 3 patients. Conclusion Insertion of self expandable metallic stent in benign tracheo-bronchial disease is an effective means of relieving dyspnea for only a short period, and it did not increase the long term survival. Better means of treatment of benign tracheo-bronchial stenosis in necessary.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.194-197
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• 1998

Myoepithelioma is a benign tumor composed of sheets and islands of various proportion of spindle, plasmacytoid, epitheloid, and clear cells. We are reporting of a 38-year-old woman with an extremely rare neoplasm of the trachea, myoepithelioma. The patient had an right neck mass and diagnosed presumptively as the thyroid tumor with tracheal invasion. Resection and anastomosis of the trachea with partial thyroidectomy was done. The tumor was a well circumscribed mass with solid growth pattern and composed of spindle and epitheloid cells, which were positive for S-100 protein and smooth muscle actin. In electron microscopy, a large amount of microfilaments in the cytoplasm and layers of basement membrane-like materials in the intercellular spaces were observed, which are characteristics of myoepithelioma. Patient has been well for 8 months postoperatively.

• Journal of Chest Surgery
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• v.38 no.11 s.256
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• pp.795-798
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• 2005

The treatment of choice for post-intubation tracheal stenosis is partial tracheal resection and end-to-end ana-stomosis. The surgical treatment of tracheal restenosis that results from unsuccessful repair of post-intubation tracheal stenosis is not easy. Failed reoperation results in permanent tracheostomy and loss of voice. If the first operation fails, about $4\~6$ months of period for resolution of inflammatory reaction, edema, and fibrosis is needed. The exact evaluation of the patient's status is necessary and success rate of reoperation for the appropriate candidates is over $90\%$. We report the results of treatment in two cases of tracheal restenosis that resulted from unsuccessful repair of post-intubation tracheal stenosis with review of literatures.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.236-243
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• 1998

Objectives: Local invasion of the thyroid cancer that is invasion of the upper aerodigestive tract, neurovascular structures of the neck and superior mediastinum, is infrequent and comprises of 1-16% of well-differentiated thyroid cancer. However the proximity of the thyroid gland to these structures provides the means for an invasive cancer to gain ready access into theses structures and when invasion occurs, it is the source of significant morbidity and mortality. So locally invasive thyroid cancer should be removed as much as possible, but still much debates have been exist whether the surgical method should be radical or conservative. This study was desinged to evaluate the clinical characteristics and the surgical treatment of the locally invasive thyroid cancer. Material and Methods: At the department of otorhinolaryngology of Hallym university, 10 patients diagnosed as locally invasive thyroid cancer among the 81 patients treated for thyroid cancer between 1991 to 1997 were retrospectively evaluated. Results: Of the 10 patients, 3 patients had histories of previous surgical treatment with or without radiation or radioactive iodine therapy. The site of invasion of thyroid cancer were trachea(7 cases), recurrent laryngeal nerve(5 cases), mediastinal node(5 cases), esophagus(3cases), larynx(3cases), carotid artery(3 cases), pharynx(l case), and other sites(4 cases). The operation techniques included 1 partial laryngectomy and 1 partial cricoid resection, 2 shavings and 3 window resections of the trachea, 1 sleeve resection of the trachea with end-to-end anastomosis and 1 cricotracheoplasty for tracheal invasion, 2 shavings and 1 partial esophagectomies for esophageal invasion, and 1 wall shaving and 2 partial resections with $Gortex^{\circledR}$ tube reconstruction for carotid artery invasion, and so on. Conclusions: These data and review of literature suggest that the surgical method should be perfomed on the basis of individual condition and complete removal of all gross tumor with preservation of vital structures whenever possible will offer a good result.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4529-4532
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• 2013

Background: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive blood loss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especially in elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patients undergoing the disease. Materials and Methods: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASA I or II) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n=15) and control group (n=15). After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch (130/0.4) and Ringer's solution, respectively. Blood samples were drawn from patients in both groups at five different time points: before anesthesia induction (T1), 30 min after ANH (T2), 1 h after start of operation (T3), immediately after operation (T4), and 24 h after operation (T5). Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and platelet membrane glycoprotein (CD62P and activated GP IIb/GP IIIa) were measured. Results: The perioperative blood loss and allogeneic blood transfusion were recorded during the surgery. The perioperative blood loss was not significantly different between two groups (p>0.05), but the volume of allogeneic blood transfusion in ANH group was significantly less than in control group ($350.0{\pm}70.7$) mL vs. ($457.0{\pm}181.3$) mL (p<0.01). Compared with the data of T1, the prothrombin time (PT) and activated partial thromboplastin time (APTT) measured after T3 were significantly longer (p<0.05) in both groups, but within normal range. There were no significant changes of thrombin time (TT) and D-dimer between two groups at different time points (p>0.05). SFMC and F1+2 increased in both groups, but were not statistically significant. PAC-1-positive cells and CD62P expressions in patients of ANH group were significantly lower than those at T1 (p<0.05) and T2-T5 (p>0.05). Conclusions: ANH has no obvious impact on fibrinolysis and coagulation function in elderly patients undergoing resection of liver cancer. The study suggested that ANH is safe to use in elderly patients and it could reduce allogeneic blood transfusion.