Anesthetic challenges in tracheal resection and reconstruction in a patient with adenoid cystic carcinoma and retrosternal goiter.

Abstract

This case demonstrates the successful surgical and anesthetic management of a rare combination of tracheal adenoid cystic carcinoma and retrosternal goiter, highlighting the critical interplay between surgical strategy and airway management. The multidisciplinary team implemented a staged approach: initial cervical thyroidectomy with conventional ventilation was followed by right thoracotomy for tracheal resection, utilizing left main bronchus cross-field ventilation to maintain oxygenation during airway reconstruction. Key to success was the coordinated transition between surgical phases and ventilation techniques, along with frozen section confirmation of tumor-free margins prior to anastomosis. Despite postoperative pulmonary complications requiring prolonged ventilation, the patient achieved complete recovery, underscoring how integrated surgical-anesthetic planning can address the dual challenges of tracheal obstruction and mediastinal mass effect.