In the morning of May 8, the Second Xiangya Hospital of Central South University announced that the hospital had carried out a C-shaped carbon fiber ring overhang biological artificial trachea (9 cm) reconstruction surgery on a patient with tracheal adenoid cystic carcinoma (TACC) after successful extra-long-segment tracheal resection (8.6 cm). The patient recovered smoothly after the operation, and was expected to be discharged from the hospital in the near future. The sci-tech novelty retrieval confirmed that there have been no any domestic and foreign research reports on the use of C-shaped carbon fiber external stent combined with bovine pericardial patches to prepare composite artificial trachea for reconstruction and implantation. This operation is the first in the world.
Mr. Wang, 57 years old, was diagnosed with TACC in a local hospital in December 2019. TACC is an insidious and rare malignant tumor, insensitive to radiotherapy and chemotherapy, and mainly treated by surgical resection. The total length of trachea in normal adults is generally 10-13 cm. The safe length of trachea excision is generally less than 5 cm, and in this case, the end-to-end tracheal anastomosis can be achieved after surgical resection. Due to excessive tension, extra-long-segment tracheal resection and reconstruction (extra-long than 5 cm) is prone to postoperative anastomotic leakage, causing a surgical failure. As the trachea directly exposes to the outside air, bacterial contact is inevitable. Moreover, at that time, there was no mature alternative artificial tracheal material with good biological tissue compatibility, elasticity, air tightness, and antibacterial properties available for clinical use, despite such material had always been the focus of medical biological tissue engineering research. Ultra-extra-long tracheal resection and reconstruction was an unsolved world-class problem in thoracic surgery.
In March 2020, Mr. Wang visited the Department of Thoracic Surgery, the Second Xiangya Hospital of Central South University. CT three-dimensional reconstruction and bronchial fiberscope examination revealed that the patient's tracheal tumor had grown than before, blocking more than 80% of the tracheal lumen, which seriously affected the patient's breath. The length of the tumor reached 70 mm, and the tumor had invaded the circumstance of the trachea and had a tendency to invade outwards. The team of Professor Yu Fenglei from the Department of Thoracic Surgery conducted a comprehensive examination, and the Medical Department organized a multi-disciplinary team (MDT) consultation involving physicians from the Department of Thoracic Surgery, the Department of Radiology, the Department of Anesthesiology, the Department of Respiratory Medicine, the Department of Oncology, and PETCT Center, in which the experts conducted an in-depth analysis of the patient's condition, and discussed the treatment options. Considering that the patient was generally in a relatively good condition, the tumor had no obvious systemic metastasis, and there were indications for surgery, tracheal tumor resection and simultaneous tracheal reconstruction surgery should be given in priority, but the difficulty and high risk in the surgical operation, and unpredictable postoperative complications should be noted.
At that time, there was still a lack of mature commercialized artificial tracheas. In order to solve the problem of extra-long-segment tracheal resection and reconstruction, the team of Professor Yu Fenglei proposed the use of C-shaped carbon fiber ring overhang bovine pericardial biological artificial trachea. This proposal uses the mature commercialized bovine pericardium with inactivated immune response, good tissue compatibility, high toughness, high strength and good tension resistance to make a closed tracheal wall, and then uses a C-shaped carbon fiber ring to simulate the tracheal cartilage ring, so as to form a suspension support for the bovine pericardial tracheal wall. This technique makes full use of bionics design ideas, and can replace the support from tracheal cartilage to the greatest extent.
On April 16, after nearly 10 hours of operation, the team of Professor Yu Fenglei successfully resected the trachea with a length of 8.6 cm for Mr. Wang until the pathological results of the upper and lower incisions were negative, and successfully carried out the C-shaped carbon fiber ring overhang bovine pericardial biological artificial trachea reconstruction, with reconstructed length up to 9 cm. After the operation, Mr. Wang's vital signs were stable and recovered smoothly. He could cough sputum and eat independently on the first day after the operation, and could get out of bed on the second day.
Extra-long (> 6 cm) segment tracheal resection and reconstruction had always been an international problem in the field of thoracic surgery. In this regard, there was no mature experience at home and abroad. In order to overcome this difficulty, the team of Professor Yu Fenglei has been carrying out relevant basic and animal studies since 2000, and constantly exploring new materials and methods for artificial tracheal reconstruction. "Research on the Development and Evaluation System of New Compound Artificial Tracheas" was funded by the National 863 Program in 2006, and passed the results appraisal in 2009. Related studies have been continuously funded by a number of provincial and ministerial key projects, and a number of new medical technologies have been initiated in the Department of Thoracic Surgery of the Second Xiangya Hospital, saving lives of many patients.
Source: Second Xiangya Hospital
