Surgery for tracheal cancer arising at the site of prior tracheoplasty for cicatricial tracheal stenosis

Background: Primary tracheal cancer is an extremely rare form of cancer. Of particular concern is the situation when such a primary tumor occurs at the site of a previously performed reconstructive surgery due to cicatricial stenosis of the trachea. This combination of factors significantly complicates the diagnosis and treatment of the disease, turning each such clinical case into a unique case of skin malignancy, previously used to replace a defect in the anterior wall of the trachea, requiring special attention from specialists.
Materials and Methods: The subject of the study was a patient with primary tracheal cancer who underwent reconstructive plastic surgery about 30 years ago, including the use of a cervical skin flap to repair the anterior wall of the trachea in post-tracheostomy cicatricial granulation stenosis. At the time of detection of tumor restenosis, the patient was undergoing treatment for infiltrative tuberculosis of the upper lobe of the right lung. After a course of anti-tuberculosis drug treatment, cervicosternotomy, circular tracheal resection with the formation of an anastomosis with a skin pad, and cervical-mediastinal lymphadenectomy were performed. During the intraoperative revision performed after a transverse tracheotomy, a cauliflower-like tumor was identified, originating from the distal part of the cutaneous tracheal graft, which was formed approximately 30 years ago during the final stage of surgery for cicatricial tracheal stenosis. Morphological examination of the tissue sample revealed keratinizing squamous cell carcinoma of mucosa from the skin previously used for tracheal reconstruction. No metastases were found in the lymph nodes. The postoperative period was uneventful, with uninterrupted continuation of anti-tuberculosis therapy.
Results: The clinical case demonstrates the potential for malignant transformation of skin tissue previously used in reconstructive surgery for cicatricial stenosis of the trachea, as well as confirming the possibility of radical surgery with complete tumor removal (R0).
Conclusions: Malignant transformation of cutaneous tissue incorporated into the respiratory tract during reconstructive surgery is a possible but extremely rare complication of staged reconstructive surgery. This clinical case represents a unique phenomenon, highlighting the importance of oncological monitoring and long-term follow-up of patients who have undergone such reconstructions.

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