Tracheal surgery in Germany

Dominik Herrmann, Jan Volmerig, Melanie Oggiano, Santiago Ewig, Erich Hecker

Abstract

First attempts of tracheal surgery in Germany were made in 1881 and tracheal resection was performed in dogs. First experiences in tracheal for malignant tracheal stenosis with tracheal resection and end-to-end anastomosis in humans were published in 1915 by the same surgeons. In 20th century several techniques of tracheal mobilisation and coverage of the anastomosis were developed to enable sufficient end-to-end anastomosis. Uniportal thoracoscopic techniques and extracorporal membrane oxygenation are progresses established more or less recently in the last decade. We performed a literature research in PubMed concerning tracheal surgery and evaluated data from the “Federal Statistical Office Germany”. In the later we requested extraction of data from the German diagnosis-related-groups (G-DRG)-system database concerning procedures and diagnoses affecting tracheal resection and management of tracheal injury. In 2018 in Germany, 267 patients were treated for neoplasm of the trachea and 66 patients for tracheal injury of the pars thoracica. Acquired tracheal stenosis was diagnosed in 1070 patients and tracheal stenosis after medical intervention in 740 individuals. There was no distinct difference in the number of cases of these diagnoses between 2014 and 2018. The most common tracheal operation in Germany is the closure of tracheostoma, which was performed almost 5000 times per year between 2014 and 2018. Treatment of tracheal stenosis was mainly bronchoscopic. Most frequent method was the dilatation of the stenosis without implantation of a stent in 314 cases, followed by bronchoscopic excision of tissue in 119 patients. Surgical management consisted of resection of tracheal stenosis with end-to-end anastomosis in 72 cases in 2018. Management of tracheal neoplasm was with multimodal predominantly. The management of tracheal diseases is predominately performed by bronchoscopic procedures. This affects the diagnostic procedures, as well as the therapeutic interventions. It is conspicuous that there is a lack between the number of encoded diagnoses in every field of tracheal diseases and the number of encoded diagnostic and therapeutic procedures. The reason for this circumstance is unclear.