Tracheal resection

A horizontal cut is made on the neck. The narrowed part of trachea is cut out and the 2 remaining ends of the trachea are stitched back together. Another cut may be needed on the chest, if the narrowing is very low down or very long. This may be a cut on one side below the shoulder blade between the ribs (thoracotomy) or vertical cut through the breastbone (median sternotomy). The surgeon and anaesthetist need to be specialists to be able to do airway surgery working as a team. The surgery is only done at specialist hospitals. You will need a thorough assessment and to be healthy enough to cope with the operation before tracheal resection is recommended.

You may need to be cared for on the intensive care unit at first. The airway can be swollen at first after surgery and extra support for your breathing may be needed. You may need to have an assessment of the join with a bronchoscopy or a scan. Chest drains are not routine if a cut is only made on the neck.

You will need to keep your neck flexed (chin towards your chest) at first after surgery. Lifting your chin up would put too much strain on the joined ends of the trachea in the first few days after surgery. It is routine to have a stitch between the chin and chest for safety in the first few days after surgery. You will be checked at least daily and your consultant will decide when it is safe to remove the chin stitch.

You should soon notice your breathing is easier compared to before surgery. 95 in 100 people have a good result they are happy with.

Recovery in hospital and recovery at home apply to tracheal resection.

See sections on:

• Pain control
• Exercise and physiotherapy

The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your surgeon, especially if you are worried.

General risks of thoracic surgery apply to tracheal resection.

In addition the following are risks of tracheal resection:

Minor more common risks

A pneumothorax (collapsed lung) may happen, this is treated with a chest drain. Your kidneys may not work as well after surgery but this is usually temporary and gets better with extra fluid.

Major less common risks

The narrowing may come back, the risk of this depends on the cause of the narrowing. Extra tissue (granulations) may grow at the join; bronchoscopy and removal of tissue can be done to treat this.

The nerves to the voice box run along the trachea, care is taken to protect the nerves but they may be damaged. This would cause temporary or permanent voice changes.

The join between the 2 ends of the trachea may break down. This may require further surgery and is the biggest concern at the start of recovery after surgery, this problem may be fatal. Symptoms of breakdown include fevers, difficulty breathing and neck and chest swelling. The risk of death after tracheal resection is 1 in 100, this also means 99 in 100 people recover from the surgery.

It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.

If you do not want surgery or are not fit enough to have an operation other options may include:

• Repeat bronchoscopy and dilatation
• Long term tracheostomy

If the narrowing is due to a cancer options may include:

• A stent in the trachea
• Radiotherapy
• Chemotherapy
• Palliative care

You can discuss treatment options with your hospital doctors, your Lung Cancer Nurse and your GP.