The most common tumors of the trachea and mainstem bronchi are adenoid cystic carcinoma and squamous cell carcinoma. Frequently patients with these tumors are initially diagnosed with asthma when they present with symptoms of shortness of breath or wheezing. A bronchoscopy or CT scan of the chest are often the tests that make the correct diagnosis when the patient's asthma symptoms persist or worsen. Given the location of these tumors, management by surgeons experienced in airway surgery is essential. The first important step is to obtain a safe airway, as often times at presentation these tumors are so large that a small amount of mucus in the airway may cause complete obstruction. After obtaining a safe airway, attention focuses on removal of the tumor and cure of the patient. Alternatively, if the tumor is unresectable a number of technologies are available to keep the airway open and palliate the symptom of shortness of breath due to airway obstruction. Surgeons in the Thoracic and Foregut group at USC have extensive experience with these and other unusual airway tumors, and have the necessary support from experienced anesthesiologists and nurses familiar with the complex care required before, during, and after surgery in patients with these problems. Furthermore, pioneering work at USC by the Thoracic and Foregut surgeons has opened the door for a minimally invasive approach to some of these tumors.

Stricture of the Trachea

A stricture is an inflammatory narrowing of the airway which often times occurs after prolonged endotracheal intubation or after a tracheostomy. Careful dilatation of the stricture and silicon stenting may alleviate the need for surgery in many cases. However, those patients with persistent or recurrent strictures will benefit from resection and reconstruction of the airway. Again an experienced airway surgeon is essential to ensure that all of the diseased airway is removed so that the problem does not recur post-operatively.

Particularly difficult areas of the airway to manage when involved by tumors or strictures are the subglottic larynx and the carina. The larynx, or voice box, is located at the top of the trachea, while the carina is the branch point of the trachea going to the right and left lungs. Management of tumors or strictures at these locations require a great deal of expertise, and indeed there are only a few centers in the country capable of appropriately carrying for patients with these types of problems. As part of a consultation with a USC Thoracic and Foregut surgeon about a complicated airway problem, patients receive not only a detailed description of the disease process as well as the factors that complicate management, but they also develop the confidence necessary to undergo the operation. There is no question that when dealing with complex thoracic diseases there is no substitute for experience. This experience is one of the reasons that USC is quickly becoming the West Coast center for airway disorders.

For prompt assistance contact Dr. Steven DeMeester or Dr. Jeffrey Hagen, or e-mail chestsurgery@surgery.usc.edu.