Management and Clinical Profile of Tracheal Adenoid Cystic Carcinoma: A surgical series.

Adenoid cystic carcinoma (ACC) of the trachea, represents a rare subtype of tracheal cancers, comprising merely 0.1% of respiratory tract tumors. This retrospective study aims to investigate the clinical presentation, diagnostic approaches, and outcomes of patients treated for tracheal ACC. It includes patients operated at the Thoracic Surgery Department of Abderrahmen Mami Hospital in Ariana, Tunisia between January 2000 and December 2022. 9 patients, with a mean age of 45 and a sex ratio of 0.8, predominantly presented dyspnea (80%), hemoptysis (20%), and dysphagia (20%). Chest X-rays revealed a mediastinal opacity in 5 cases (55%). Bronchoscopy showed tracheal lumen narrowing with endotracheal budding in all cases. Thoracic CT scans and MRI facilitated precise localization, predominantly in the lower 1/3 of the trachea (60%). Surgical interventions involved tracheal resection with anastomosis. Cervicotomy was the primary approach (40%), followed by posterolateral thoracotomy (22%) and left hemi-clamshell (10%) in one case due to tumor extension. Early postoperative complications affected two patients, including one case of bleeding necessitating reoperation and resulting in mortality. The average length of hospitalization was 11 days. Histopathological analysis confirmed the diagnosis of ACC in all cases, and the average tumor size was 5 cm. Seven patients (77%) received adjuvant radiotherapy. An instance of pulmonary metastasis was detected after 14 years, requiring successful intervention. Tracheal ACC, although exceptionally rare, mandates meticulous clinical consideration. Surgery remains the treatment of choice, with radiotherapy considered in adjuvant scenarios.