Laryngotracheal reconstruction versus crico-tracheal resection for laryngotracheal stenosis: comparison of surgical outcomes in a pediatric population.

OBJECTIVES

Laryngotracheal reconstruction (LTR) and partial crico-tracheal resection (PCTR) are the gold-standard treatments for pediatric laryngotracheal stenosis (LTS). However, they may lead to different rates of decannulation, complications, and retreatments. We compared the outcomes in pediatric patients who underwent LTR and PCTR.

METHODS

We conducted a retrospective monocentric data review of patients who underwent LTR and PCTR for LTS between 2009 and 2023. We compared decannulation rates, complication rates, and the need for adjuvant treatment between groups. We analyzed risk factors associated with adverse outcomes.

RESULTS

We included 59 patients, 30 (50.8%) underwent LTR and 29 (49.2%) PCTR. There was no difference between groups in age, sex, aetiology, or stenosis grade, as assessed by the ELS (European Laryngological Society) score. The overall decannulation rate (57% for LTR vs 71% for PCTR, p = NS), complication rate (53.3% for LTR vs 65.5% for PCTR, p = NS), and need for additional treatments (73.2% for LTR vs 51.7% for PCTR, p = NS) were comparable. The presence of comorbidities was associated with a lower overall decannulation rate (28.6% with vs. 77.4% without, p = 0.002). Comorbidities (72.4% with vs. 41.4% without, p = 0.03) and ELS score (37.3% for ELS ≥ IIIb vs. 18.6% for ELS < IIIb, p = 0.002) were more frequent in patients requiring additional treatments. Complications were more frequent in patients with higher ELS score (39% for ELS ≥ IIIb vs. 20.3% for ELS < IIIb, p = 0.002).

CONCLUSIONS

LTR and CTR/TR for pediatric LTS showed comparable outcomes. However, patients with comorbidities had lower decannulation rates and required more treatments. A higher stenosis grade was more frequently associated with complications.