Robotic-assisted tracheal resection for adenoid cystic carcinoma with extracorporeal membrane oxygenation support

摘要

Central MessageRobotic-assisted resection/reconstruction of tracheal ACC under ECMO appears feasible and safe surgical procedure.See Commentary on page XXX. Robotic-assisted resection/reconstruction of tracheal ACC under ECMO appears feasible and safe surgical procedure. See Commentary on page XXX. Adenoid cystic carcinoma (ACC) is a rare malignant tumor originating from secretory glands and is the second most common primary tracheal tumor, accounting for approximately 10% to 15% of cases.1Gaissert H.A. Grillo H.C. Shadmehr M.B. Wright C.D. Gokhale M. Wain J.C. et al.Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina.Ann Thorac Surg. 2004; 78: 1889-1896Abstract Full Text Full Text PDF PubMed Scopus (223) Google Scholar Surgical resection with tumor-free margins is the current standard treatment for tracheal ACC but may be technically difficult and hazardous to the patient given the frequently extensive airway involvement. Sometimes the extension of the resection may be less than optimal due to the high risk of surgical procedure complications (eg, necrosis, dehiscence, granuloma formation, and stenosis). In these cases, the presence of microscopic tumor in the specimen margins that is effectively treated by adjuvant radiotherapy is generally accepted.2Grillo H.C. Primary tracheal neoplasms.in: Surgery of the Trachea and Bronchi. Decker, 2004: 207-249Google Scholar Tracheal resection/reconstruction is typically performed via thoracotomy, but nowadays, less invasive techniques have been adopted.3Li J. Wang W. Jiang L. Yin W. Liu J. Shao W. et al.Video-assisted thoracic surgery resection and reconstruction of carina and trachea for malignant or benign disease in 12 patients: three centers' experience in China.Ann Thorac Surg. 2016; 102: 295-303Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar,4Li S. Ai Q. Liang H. Liu H. Yang C. Deng H. et al.Nonintubated robotic-assisted thoracic surgery for tracheal/airway resection and reconstruction: technique description and preliminary results.Ann Surg. 2022; 275: e534-e536Crossref PubMed Scopus (11) Google Scholar In particular, a robotic approach for tracheal surgery has gained popularity in highly selected cases and has been found to be safe, feasible, and effective.4Li S. Ai Q. Liang H. Liu H. Yang C. Deng H. et al.Nonintubated robotic-assisted thoracic surgery for tracheal/airway resection and reconstruction: technique description and preliminary results.Ann Surg. 2022; 275: e534-e536Crossref PubMed Scopus (11) Google Scholar,5Qiu T. Zhao Y. Song J. Jiao W. Robotic circumferential tracheal resection and reconstruction via a completely portal approach.Thorac Cancer. 2019; 10: 378-380Crossref PubMed Scopus (3) Google Scholar Tracheal resections/reconstructions can be very challenging even with the use of cross-field ventilation techniques due to impaired surgical access and visibility. Also, the lack of hemodynamic stability can become a problem in cases of extended retraction when mediastinal maneuvers are needed. In this situation, the use of extracorporeal membrane oxygenation (ECMO) helps to perform a complex surgical procedure in a technically easier way. We describe the case of robotic-assisted tracheal resection for ACC with ECMO support. We believe this is the first report with this approach. An institutional review board exemption was obtained for this retrospective review and the patient provided informed consent for publication of study data. A 33-year-old woman was diagnosed with an endotracheal lesion on a chest contrast-enhanced computed-tomography (CT) scan performed for persistent dyspnea and confirmed by positron-emission tomography scan. On CT scan, the lesion was 18 mm in length and located at 85 mm from the glottic plane with extension anteriorly into the mediastinum (Figure 1, A). Initially, the endotracheal neoplasm was removed by rigid bronchoscopy confirming a primary ACC. The patient