Work

Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society

Year: 2026

Type: article

Abstract: Objective: Tracheal (TRA) and crico-tracheal resection and anastomosis (CTRA) are highly effective surgical procedures for managing selected cases of laryngo-tracheal stenosis, although the absence of a standardised classification limits the use of a common language within the scientific community and hinders multicentre comparisons. We present the European Laryngological Society (ELS) proposal, categorising (C)TRA into 6 Types (A1, A2, B, C, D, and E) mainly based on their anatomical extension and type of anastomosis performed. Methods: The classification was validated through a preliminary multicentre cohort of 390 patients treated between September 1996 and March 2026 in 4 European referral airway centres sharing a common protocol for definitions of (C)TRA. Primary outcomes included postoperative complications and airway patency in terms of tracheostomy-free rate. Results: The cohort was distributed across (C)TRA Type A1 (24.9%), A2 (21%), B (19%), C (31%), D (1.5%), and E (2.6%). Overall and anastomosis-specific complication rates increased from Type A1 to Type C, reflecting the technical burden of the procedure, while planned temporary tracheotomy in Types D and E effectively mitigated acute airway morbidity. Long-term functional success remained high across all (C)TRA Types, with tracheostomy-free rates ranging from 95.1% to 100% for all different kinds of (C)TRA procedures. Conclusions: The proposed ELS classification provides a standardised framework that correlates well with surgical complexity and complication profiles, enhancing data comparability and serving as a valuable didactic resource for the international airway community.

Source: Acta Otorhinolaryngologica Italica

DOI: 10.14639/0392-100x-a2467