National Utilization of Surgery and Outcomes for Primary Tracheal Cancer in the United States

Background. Tracheal cancer (TC) is a rare disease, and surgical treatment requires a high level of expertise. We sought to determine the treatment patterns and surgical outcomes of TC in the United States. Methods. The National Cancer Database was queried for all cases of primary invasive TC without distant metastatic disease between 2004 and 2015. Primary surgical treatment and outcomes were analyzed. Factors associated with utilization of surgery and overall survival were tested using regression analysis. Results. Of 1379 identified TC patients, 338 patients (25%) were treated surgically. Among resected patients, most had adenoid cystic (48%) or squamous cell (28%) carcinoma. Median length of hospital stay after resection was 7 days (interquartile range, 3-8), and 30-day mortality was 1.4%. Most nonsurgically managed patients underwent radiation (63%). Factors associated with surgical resection were younger age, higher education level, tumor size, and adenoid cystic histology. On multivariate analysis patients were also more likely to undergo surgery if they traveled a farther distance for treatment (>45 km; odds ratio, 1.53; 95% confidence interval, 1.09-2.13) or were treated at academic centers (odds ratio, 1.68; 95% confidence interval, 1.25-2.26). Five-year overall survival was 71% after resection, 39% after surgical debulking, and 31% without surgery (P <.001). Conclusions. National surgical outcomes for resection of TC demonstrate low perioperative mortality and excellent long-term prognosis. However, few non-metastatic TC patients underwent surgery, indicating disparities in access to optimal surgical care and variability in practice patterns at a national level. (C) 2020 by The Society of Thoracic Surgeons.