Tracheal Papilloma at Peking University Third Hospital: Abandoning Intubation Intraoperatively for Laryngeal Mask Anesthesia with Superficial Cervical Plexus Block
🔎 Recently, the thoracic surgery team led by Dr. Guangliang Qiang at Peking University Third Hospital performed a tracheal tumor resection and reconstruction in a 51-year-old man. He presented with recurrent cough and nocturnal awakenings due to breathlessness. Bronchoscopy showed an irregular, highly vascular lesion with a hyperemic base in the main trachea, approximately 5 cm below the glottis and 6 cm above the carina.
📋 The patient had a 35-year history of heavy smoking and a family history of clustered malignancies. PET/CT showed a small intraluminal tracheal nodule with no evidence of distant metastasis. After multidisciplinary discussion, endotracheal intubation under general anesthesia was selected as the primary plan, with laryngeal mask general anesthesia combined with superficial cervical plexus block and preserved spontaneous breathing prepared as a contingency.
⚠️ The key decision in this case was made intraoperatively. Repeat tracheoscopy under laryngeal mask ventilation showed that the lesion was friable and highly vascular. Passing an endotracheal tube through this segment risked abrading the tumor, causing bleeding, or dislodging fragments that could obstruct the distal airway. The team therefore abandoned intubation and activated the contingency plan.
🛠️ Through a small curved cervical incision, and with tracheoscopic localization, the affected tracheal segment was completely resected. Intraoperative frozen section confirmed negative margins, followed by end-to-end tracheal anastomosis. A ventilation leak test showed no air leak.
📊 Intraoperative blood loss was approximately 5 mL, and vital signs remained stable. The patient removed the laryngeal mask himself after awakening. Bronchoscopy on postoperative day 4 showed good anastomotic healing without stenosis, and he was discharged on postoperative day 8. Final pathology confirmed tracheal papilloma (squamous type) with negative margins.
💡 Our takeaway: for friable, highly vascular intraluminal tracheal lesions, intubation itself may become a source of risk. Preparing a non-intubated contingency before surgery and adjusting to intraoperative findings was the main lesson of this case.
📌 Important caveats:
• Tracheal surgery under non-intubated, spontaneous-breathing anesthesia has been reported in the literature. This case is an application of the technique at our center, not a new method.
• The lesion was located in a segment accessible through a cervical incision, and the pathology was benign. The findings cannot be generalized to all tracheal tumors.
• This is a single-case experience. Long-term follow-up, including recurrence, is still needed.
