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Peer-reviewedCC BY-NC-NDActa otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale

Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society.

  • Cesare Piazza1
  • Giorgio Peretti2
  • Davide Lancini1
  • Kishore Sandu3
  • Marta Filauro2
  • Jan Constantin Koelmel4
  • Francesco Mattioli5
  • Cecilia Molendi1
  • Christoph Arens6
  • Christian Sittel4
  • Reza Nouraei7
7 affiliations
  1. 1Unit of Otorhinolaryngology - Head and Neck Surgery, ASST - Spedali Civili of Brescia, Comprehensive Cancer Center,, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
  2. 2Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, School of Medicine, Genoa, Italy.
  3. 3Department of Otorhinolaryngology, University Hospital - CHUV, Lausanne, Switzerland.
  4. 4Department of Otorhinolaryngology - Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany.
  5. 5Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy.
  6. 6Department of Otorhinolaryngology - Head and Neck Surgery, Medical Faculty, University of Giessen, Giessen, Germany.
  7. 7The Loxley Centre for Airway, Voice and Swallowing, Department of Otorhinolaryngology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Abstract

Objective

Tracheal (TRA) and crico-tracheal resection and anastomosis (CTRA) are highly effective surgical procedures for managing selected cases of laryngo-tracheal stenosis, although the absence of a standardised classification limits the use of a common language within the scientific community and hinders multicentre comparisons. We present the European Laryngological Society (ELS) proposal, categorising (C)TRA into 6 Types (A1, A2, B, C, D, and E) mainly based on their anatomical extension and type of anastomosis performed.Methods

The classification was validated through a preliminary multicentre cohort of 390 patients treated between September 1996 and March 2026 in 4 European referral airway centres sharing a common protocol for definitions of (C)TRA. Primary outcomes included postoperative complications and airway patency in terms of tracheostomy-free rate.Results

The cohort was distributed across (C)TRA Type A1 (24.9%), A2 (21%), B (19%), C (31%), D (1.5%), and E (2.6%). Overall and anastomosis-specific complication rates increased from Type A1 to Type C, reflecting the technical burden of the procedure, while planned temporary tracheotomy in Types D and E effectively mitigated acute airway morbidity. Long-term functional success remained high across all (C)TRA Types, with tracheostomy-free rates ranging from 95.1% to 100% for all different kinds of (C)TRA procedures.Conclusions

The proposed ELS classification provides a standardised framework that correlates well with surgical complexity and complication profiles, enhancing data comparability and serving as a valuable didactic resource for the international airway community.

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Cite

BibTeXRIS
BibTeX
@article{piazza2026classification,
  title = {{Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society.}},
  author = {Cesare Piazza and Giorgio Peretti and Davide Lancini and Kishore Sandu and Marta Filauro and Jan Constantin Koelmel and Francesco Mattioli and Cecilia Molendi and Christoph Arens and Christian Sittel and Reza Nouraei},
  journal = {Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale},
  year = {2026},
  month = oct,
  doi = {10.14639/0392-100x-a2467},
  url = {https://europepmc.org/article/MED/42969776},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society.
AU  - Cesare Piazza
AU  - Giorgio Peretti
AU  - Davide Lancini
AU  - Kishore Sandu
AU  - Marta Filauro
AU  - Jan Constantin Koelmel
AU  - Francesco Mattioli
AU  - Cecilia Molendi
AU  - Christoph Arens
AU  - Christian Sittel
AU  - Reza Nouraei
PY  - 2026
DA  - 2026/10/01
JO  - Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale
DO  - 10.14639/0392-100x-a2467
UR  - https://europepmc.org/article/MED/42969776
AB  - Objective  Tracheal (TRA) and crico-tracheal resection and anastomosis (CTRA) are highly effective surgical procedures for managing selected cases of laryngo-tracheal stenosis, although the absence of a standardised classification limits the use of a common language within the scientific community and hinders multicentre comparisons. We present the European Laryngological Society (ELS) proposal, categorising (C)TRA into 6 Types (A1, A2, B, C, D, and E) mainly based on their anatomical extension and type of anastomosis performed.Methods  The classification was validated through a preliminary multicentre cohort of 390 patients treated between September 1996 and March 2026 in 4 European referral airway centres sharing a common protocol for definitions of (C)TRA. Primary outcomes included postoperative complications and airway patency in terms of tracheostomy-free rate.Results  The cohort was distributed across (C)TRA Type A1 (24.9%), A2 (21%), B (19%), C (31%), D (1.5%), and E (2.6%). Overall and anastomosis-specific complication rates increased from Type A1 to Type C, reflecting the technical burden of the procedure, while planned temporary tracheotomy in Types D and E effectively mitigated acute airway morbidity. Long-term functional success remained high across all (C)TRA Types, with tracheostomy-free rates ranging from 95.1% to 100% for all different kinds of (C)TRA procedures.Conclusions  The proposed ELS classification provides a standardised framework that correlates well with surgical complexity and complication profiles, enhancing data comparability and serving as a valuable didactic resource for the international airway community.
SN  - 0392-100X
SN  - 1827-675X
ER  -