Two-Stage Tracheal Repair for Well-Differentiated Thyroid Carcinoma With Tracheal Invasion.

OBJECTIVE: To evaluate a two-stage tracheal reconstruction strategy for repairing extensive tracheal defects in well-differentiated thyroid carcinoma (WDTC) with tracheal invasion. METHODS: Seventy-four patients underwent tumor resection and tracheal excision, followed by staged reconstruction using a free posterior tibial flap (n = 28), pedicled thoracoacromial flap (n = 36), or pedicled supraclavicular flap (n = 10). Functional recovery, decannulation, complications, and survival were analyzed. RESULTS: Demographic characteristics were comparable across groups. Tracheal defects were significantly larger in the free posterior tibial artery perforator flap group (9.14 ± 1.57 rings) versus the pedicled thoracoacromial (5.89 ± 2.59 rings) and supraclavicular (6.30 ± 1.49 rings) flap groups. The overall endotracheal tube removal rate was 95.9%, with no intergroup differences (p = 0.533). Functional recovery (swallowing, speech, and respiration) was comparable among groups. The 3-year survival rate was 78.4%, with no significant differences across groups (p = 0.633). CONCLUSIONS: Two-stage tracheal reconstruction is a safe and effective approach for long-segment tracheal defects in WDTC patients, offering satisfactory functional recovery. Further studies with larger cohorts and longer follow-up are warranted to confirm long-term efficacy.