Neoadjuvant therapy followed by tracheal/carinal resection and reconstruction: perioperative and long-term outcomes

Background: Whether neoadjuvant therapy affects subsequent pathological, surgical, or survival outcomes of primary tracheal tumors remains unclear. This study aimed to evaluate the clinical efficacy, perioperative outcomes and long-term survival associated with neoadjuvant therapy in patients with primary tracheal tumors.

Methods: Clinical records from 2019 to 2024 were retrospectively reviewed to identify patients who underwent tracheal resection and reconstruction following neoadjuvant therapy. Perioperative, surgical, pathological, and survival outcomes were systematically analyzed to assess the impact of neoadjuvant treatment.

Results: A total of 22 patients with primary tracheal tumor who received neoadjuvant therapy followed by surgical resection were included. Following preoperative treatment, 8 patients (36.4%) showed a favorable pathological response, including 4 (18.2%) with complete pathological response and 4 (18.2%) with major pathological response. Complete (R0) resection was observed in 16 patients (72.7%). Postoperative complications occurred in 13 patients (59.1%), with 10 experiencing more than one event. Major complications (Clavien-Dindo grade III–V) were noted in 5 patients (22.7%). Anastomotic complications developed in 4 patients (18.2%), including 3 with dehiscence and 1 with stenosis. There were no 30- or 90-day mortalities. After a median follow-up of 29.5 months (range, 6–88 months), the 5-year overall survival and disease-free survival rates were 68.7% and 58.8%, respectively.

Conclusions: Neoadjuvant therapy may be a safe and potentially effective option for carefully selected patients with primary tracheal tumors. In our cohort, tracheal resection and reconstruction after neoadjuvant treatment were feasible, with acceptable perioperative outcomes and encouraging long-term outcomes.