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September 26, 1966

Management of Cervical and Mediastinal Lesions of the Trachea

JAMA. 1966;197(13):1085-1090. doi:10.1001/jama.1966.03110130085023

Although many tracheal tumors are benign or of low-grade malignancy, without local invasion or metastases, cure has been rare because dependable methods of wide circumferential excision and reconstruction have not been available.

In the thorax, it was believed that only four tracheal rings (2 cm) could be removed and an end-to-end anastomosis done. Prosthetic replacements often fail, because of (1) leakage, with fatal mediastinitis; (2) stenosis, due to scarring and fatigue of prostheses; (3) recurrent tumor, due to inadequate resection; and (4) hemorrhage, due to erosion by prostheses.

In the neck, reconstructive methods have often been complex, slow to heal, and many-staged. Excision of the trachea without replacement—with permanent end-tracheostomy—is not satisfactory when a functional larynx remains.

Review of past experience with 32 primary tumors of the trachea treated at the Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary, Boston, during a period of 25 years reveals that