role of tracheal stenting as an alternative treatment in cicatricial and non-operable tracheal stenosis

Tracheal stenosis is normally caused by trauma, infection, benign and malignant tumors, prolonged intubation or tracheostomy. The best treatment for tracheal stenosis is resection and anastomosis of trachea. Yet the major surgical complication of tracheal surgery is postoperative stenosis. The goal of this paper is to study the result of tracheal stenting as a replacement therapy for patients suffering from tracheal stenosis who are not good candidates for surgery. This study presents the results of stenting in patients with: Inoperable tumoral stenosis,Non-tumoral stenosis being complicated due to prior surgeries,Inability to undergo a major surgery. The study was performed between September 2002 and July 2011 and poly flex stents were used by means of rigid bronchoscopy. A total of 25 patients received stents during this study. Among them 15 patients suffered from benign and 10 suffered from malignant tracheal stenosis. The patients were followed up for at most 12 months after the stenting operation. The mean age of the patients was 35 years. The most common cause of stenosis was prolonged intubation [75%]. The most common indication for stenting was the history of multiple tracheal operations. The most common complication of stenting and cause of stent removal was formation of granulation tissue. 30% of patients with benign tracheal stenosis were cured and about 10% improved until they could stand a major operation. Ten patients in benign group and 2 patients in malignant group [20%] needed T-Tube insertion after stent removal but other patientcure by stenting. In benign cases stenting is associated with recurrence of symptoms which requires other therapeutic techniqus, so the stenting may not be named as a final solution in benign cases. However, this technique is the only method with approved efficacy for malignant cases with indication

Anterior trans cervicothoracic approach for complete resection of cervicothoracic mediastinal neurogenic tumors

Introduction: Neurogenic mediastinal tumors comprise a wide range of benign and malignant diseases. A group of these tumors, located at thoracic apex, sometimes spread to cervical spaces causing numerous surgical difficulties. In thoracotomy approaches, due to proximity of the tumors to major blood vessels, complete removal of these tumors from cervical spaces is impossible or may cause intraoperative severe bleeding or other dangerous incidents Because of the adjacent major vessels that are not visible. The aim of this study is to report cases of surgical treatment of such tumors using Anterior Trans Cervicothoracic Approach [ATCA]

Materials and Methods: All patients with neurogenic tumors and cervicomediastinal [CM] spread who underwent surgey with ATCA technique during 2005-2011 were included in our study. Then they were evaluated in terms of age, sex, clinical symptoms, radiological and pathological findings, technical success rate of the surgery, surgical complications and first-year relapse rate after the surgery

Results: Our study included 10 patients from whom 9 were female and 1 was male [M/F= 1/9] and the mean age was 27 years. The most common symptoms were pain and feeling of a lump. All patients were operated by this technique successfully. The most common pathological finding was neurofibroma [in 5 patients] and surgical complications occurred in 2 patients [20%] [Wound infection in 1 patient and brachial plexus injury in another patient]. There was no mortality. Disease relapse was reported in 1 patient ganglioneuroblastoma who underwent surgical resection for the second time

Conclusion: Considering the successful removal of the tumors and favorable exposure of major vessels in cervicomediastinal spaces, this technique is recommended to resect mediastinal tumors with spread to cervical spaces. However, a more definite conclusion requires further studies

Thoracoscopic splanchnicectomy for pain control in unresectable pancreatic cancer

Severe pain is a major problem in patients with unresectable pancreatic cancer. The goal of this study is to evaluate the effects of Thoracoscopic Splanchnicectomy [TS] on pain control in these patients suffering from unresectable pancreatic cancer Between years 2000 to 2011, 20 patients suffering from unresectable pancreatic cancer underwent TS due to severe pain. They were studied in terms of age, sex, location of pancreas tumor, history of previous surgery, response to treatments for pain control [assessed with VAS scoring system] and complications of surgery Male to female ratio was 14/6 with a mean age of 63 years. The most common tumor site was at the pancreas head [in 8 patients]. The most cause of unresectability was local expansion to critical adjacent elements [in 10 patients]. Surgery was performed successfully in all patients. Postoperative complication included only pleural effusion on the left side which was cured by proper treatment. There were no post-op mortalities. Fifteen patients had acceptable levels of pain at the end of a six month follow-up period TS provides good pain control, little side effects and minimal invasiveness, the technique is recommended for pain control in patients with unresectable pancreatic cancer