Benoit Jacques Bibas1, Lily Yu2, Margo Chen2
1Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, Brazil; 2TCR Editorial Office, AME Publishing Company
Correspondence to: Margo Chen. TCR Editorial Office, AME Publishing Company. Email: tcr@amepc.org.
Editor’s note
Translational Cancer Research (TCR) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year TCR launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.
The special series “Recent Developments in Benign Tracheal Stenosis” (1) led by Dr. Benoit Jacques Bibas (Figure 1), Dr. Paulo Francisco Guerreiro Cardoso and Dr. Konrad Hoetzenecker has attracted many readers since its publication. This special series aims to provide an update on the recent developments in benign tracheal stenosis. Conditions such as stenosis and tracheostomies not only inflict profound suffering on those afflicted but also impose a significant burden on the healthcare system, characterized by high rates of morbidity and mortality, alongside substantial economic costs. At this moment, we are honored to have an interview with Dr. Bibas to share his scientific career experience and insights on this special series.
Figure 1 Dr. Benoit Jacques Bibas
Expert introduction
Dr. Bibas is an attending thoracic surgeon at the Heart Institute (InCor) of the University of São Paulo in Brazil. He obtained his MD degree at the Federal University of Rio de Janeiro (UFRJ) in 2005. He completed his residency program in Thoracic Surgery at the University of São Paulo from 2008 to 2011, and a fellowship in Tracheal Surgery from 2011 to 2013. He is currently enrolled in the PhD program of the University of São Paulo.
His research focuses on clinical and surgical aspects of tracheal diseases, such as benign tracheal stenosis, tracheoesophageal fistula, complex laryngotracheal problems, and rigid bronchoscopy for neoplastic airway obstruction. Furthermore, he is interested in predictors for surgical complications, development of clinical trials, databases, and minimally invasive thoracic surgery. He currently leads a taskforce that created an international database of surgical treatment of tracheal diseases.
Dr. Bibas published more than 40 papers in prestigious peer reviewed journals and serves as invited reviewer in many journals. He is an editorial board member of Translational Cancer Research and BMC Pulmonary Medicine. He is an active member of the Brazilian Society of Thoracic Surgery (SBCT), and the European Society of Thoracic Surgeons (ESTS).
Interview
TCR: What motivated you to specialize in the field of thoracic diseases?
Prof. Bibas: I became acquainted with thoracic diseases, and thoracic surgery, very early during my medical education. My father was also a thoracic surgeon, and I would often accompany him to the operating room as a medical student. Thus, I was able to appreciate the field and it soon became a fascination. Later, during the general surgery residency I would often seek the thoracic surgery group and assist them during operations, even if it wasn’t my rotation. Lastly, I was able to enter the thoracic surgery residency program at the University of São Paulo, where I am currently a staff surgeon. There I could see and practice every aspect of the specialty and dedicate most of my practice to airway surgery.
TCR: You mentioned that Health-related quality of life (HRQL) assessment have a significant impact on patients' quality of life. Could you discuss particularly how HRQL inform treatment decisions and improve patient outcomes?
Prof. Bibas: Health-related quality of life is not a new concept. Nonetheless, it`s incorporation in medical practice is somewhat recent. Early reports regarding tracheal resection and reconstruction focused primarily on surgery success. And it was a binary outcome. Good anastomosis or restenosis. It is of utmost importance to understand that multiple factors interfere with the operative result: Voice, swallowing, mental health, exercise capacity, etc. To simply state that the operation had a good outcome, and no further procedure was needed is currently not acceptable. It is our duty as physicians to understand how all those features interact to be able to provide the best surgical result for our patients.
TCR: With the increasing depth of understanding that researchers have gained regarding laryngotracheal diseases in recent years, what do you see as the most significant challenges in the diagnosis and treatment of laryngotracheal diseases, and how do you think these challenges can be addressed?
Prof. Bibas: Regional data from emerging countries suggest a high prevalence of post-intubation airway stenosis, which can vary from 2,3 to 17%. In fact, the real incidence of post-intubation tracheal stenosis in Brazil, as well as in other emerging countries is probably underrated. In Brazil the proportion of hospitalizations due to external causes, such as traffic accident and violence, has increased steadily in recent years, unlike in the developed countries. At our institution, most patients with post-intubation stenosis are trauma victims with head injuries that are often submitted to tracheostomy at the primary care center before they are referred to our center. At present, more than 80% of our patients with subglottic or tracheal stenosis have a tracheostomy tube when referred to our institution. Furthermore, the incidence of post-intubation tracheal stenosis will not decrease in the upcoming years since the COVID-19 pandemic has put a severe strain in the health care systems, with thousands of patients submitted to prolonged mechanical ventilation. So, we can expect a high number of patients with post-intubation tracheal stenosis in the upcoming years.
TCR: Looking towards the future, what do you believe is the most promising direction for research and treatment of laryngotracheal diseases, and what obstacles need to be overcome to achieve progress in this direction?
Prof. Bibas: Future insights into the pathophysiology and molecular aspects of the development of airway stenosis are certainly exciting. A better understanding of this disease has been demonstrated by recent studies. Moreover, the role of genetics and perhaps targeted therapy are also promising. The understanding of why someone develops airway stenosis and other individuals don’t`, should be the focus of our future research.
TCR: Have you recently conducted any research projects related to the topic of this series? If so, could you share some of your key findings?
Prof. Bibas: I am currently on final process of publishing my PhD thesis. We performed a prospective study that aimed to look at complications following T-Tube insertion for patients with benign tracheal stenosis. Tubes were positioned below (most cases) or above the vocal folds as needed. Supraglottic T-tubes are a controversial topic, and most groups prefer not to use it. Our group has used supraglottic T-tubes for high laryngotracheal stenosis that are close to the vocal folds, but not amenable to surgery. We demonstrated that this technique has good medium-term results but does have a higher percentage of complications (twice fold) when compared to infraglottic T-tubes.
TCR: If given an opportunity to update this special series, what would you like to moderate, add or emphasize to provide a more informative series?
Prof. Bibas: We would certainly need to include the impact of COVID-19 in the development of airway stenosis. Some researchers claim that stenosis following COVID infection is an entirely new condition, and that it has an immunological background. Other manuscripts have suggested that resection in this setting has more postoperative complications, especially granulation tissue, with the need for more interventions. Moreover, we would need to look deeper into the pathophysiology of airway stenosis, mainly postintubation and idiopathic subglottic stenosis.
Reference
- Recent Developments in Benign Tracheal Stenosis. Available online: https://tcr.amegroups.org/post/view/recent-developments-in-benign-tracheal-stenosis