Tracheobronchoplasty outcomes: a narrative review

Abstract

Objective: Herein, we will summarize the most recent adult tracheobronchoplasty outcome data available. We hope this review will encourage others to report their outcome data and allow clinicians to design studies that capture previously reported outcome measures, so that novel and established therapies can be appropriately evaluated. Background: Excessive central airway collapse (ECAC) consists of excessive dynamic airway collapse (EDAC) and severe tracheobronchomalacia (TBM), two aberrant pulmonary physiologies that refer to the inappropriate movement of the central airway. Typically, EDAC involves the abnormal movement of the posterior membrane, while TBM relates to changes in the cartilaginous portion of the trachea. All can cause debilitating respiratory symptoms. In general, these symptoms can mimic or overlap with common pulmonary diseases such as asthma and chronic obstructive pulmonary disease likely making diagnosis of ECAC underreported. Although screening protocols for ECAC are non-existent, once diagnosed, surgical intervention or tracheobronchoplasty can be offered to highly selected patients at centers with complex airway disease expertise. The preoperative evaluation of patients requires a multi-disciplinary approach. Comorbid conditions are then optimized, and patients with persistent symptoms that are surgical candidates often undergo a temporary stent trial over the course of 1–2 weeks to assess improvement of subjective and objective parameters. This process can help determine if a tracheobronchoplasty is likely to offer symptomatic relief. The scope of this review is to compile the recent data in severe adult TBM. Methods: A narrative review through the PubMed (MEDLINE) database was performed using the keyword tracheobronchoplasty. Non-pediatric studies pertaining to perioperative, subjective, and objective outcomes after tracheobronchoplasty for severe symptomatic TBM in adults published between 2010–2020 were retained. Single patient case reports were excluded. Six publications from two institutions met inclusion criteria. Conclusions: Almost half of the patients that undergo tracheobronchoplasty for severe symptomatic TBM will experience a perioperative complication (minor or major) regardless of operative approach. With appropriate patient selection, authors have demonstrated improvement of patient reported, objective, and functional outcomes. Current literature is limited to single center retrospective reviews from two institutions. More data can refine the current treatment paradigms and establish improved outcome metrics.