Paulo Francisco Guerreiro Cardoso1, 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.
This special series “Recent Developments in Benign Tracheal Stenosis” (1) is edited by Dr. Paulo Francisco Guerreiro Cardoso (Figure 1), Dr. Benoit Jacques Bibas, 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 Prof. Cardoso to share his scientific career experience and insights on this special series.
Figure 1 Prof. Paulo Francisco Guerreiro Cardoso
Expert introduction
Prof. Cardoso is an attending Thoracic Surgeon, Senior Thoracic Surgery Researcher, and Professor in the Division of Thoracic Surgery at the Heart Institute (InCor) of the Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil. His areas of expertise are general thoracic surgery, airway surgery, and interventional respiratory endoscopy. Research lines (experimental and clinical) in airway surgery, regenerative medicine applied to the central airways, and interventional airway endoscopy.
Interview
TCR: What inspired you to become thoracic surgeon?
Prof. Cardoso: My interest in thoracic surgery started when I was a surgical resident in early 1980´s. The rotation in Cardiothoracic Surgery introduced me to lung and airway surgery. My former interest and focus were on airway, lung, and pleural physiology. At the end of my training, I embarked on a Master´s Degree program in Thoracic Surgery and became a specialist thereafter.
TCR: As you mentioned in the editorial, some degree of stenosis develops in up to 20% to 30% of patients with tracheostomy. What do you think are the main factors that cause and worsen tracheal stenosis? Are there any measures to prevent or reduce tracheal stenosis?
Prof. Cardoso: The most frequent causes of airway stenosis in adults are post-intubation and post-tracheostomy. The incidence varies from 0.6% to 20% and is higher in the developing countries where the airway care of patients submitted to orotracheal intubation or tracheostomy is insufficient. Less frequent causes of benign tracheal stenosis include idiopathic, Wegener´s granulomatosis, infectious and deposit diseases. The contributing factors for aggravation of benign tracheal stenosis are related to the inadequate care and handling of the tracheal devices (e.g., tracheostomy cannula), lack of a regular follow up after hospital discharge, and limited access to interventional pulmonology. Other factors include pathologic gastroesophageal reflux, local airway microbiota and inflammation. Preventive measures include adequate airway care in the intensive care setting, correct technical performance and placement of the tracheostomy. After hospital discharge, patients must undergo regular follow-up visits to detect signs and symptoms of stenosis, such as dyspnea and stridor. In this regard, the early detection in selected patients may require more invasive approaches such as airway endoscopy and CT scans.
TCR: The use of 3D printing models as a tool for planning endoscopic treatment of benign airway stenosis is an exciting development in the field of otolaryngology. What are your thoughts on 3D printing models in the treatment of thoracic disease and how do you think it will evolve in the coming years?
Prof. Cardoso: Our Division of Thoracic Surgery is on a tertiary academic hospital that is a reference center for airway diseases. Therefore, our referral includes complex cases that require an individualized approach. The 3D printing and modelling of the central airway can be advantageous in cases of complex stenosis, either for planning reconstructive airway surgery or as a tool for manufacturing personalized airway prosthesis. The Department of Bioengineering of the hospital has recently incorporated a bioprinter capable of creating models of stenosis based on CT scan images. We are still in the early stages of airway modeling but we believe this will become a valuable resource for manufacturing customized prosthesis for treatment of airway stenosis.
TCR: Research on Tracheal Stenosis is flourishing. What do you see as the most important direction for future studies on Benign Tracheal Stenosis? Are there any particular challenges or obstacles that need to be overcome in order to make progress in this direction?
Prof. Cardoso: Airway stenosis is basically an inflammatory disease. A better understanding of the mechanisms and markers of both inflammation and tissue repair are important for the development of new treatment strategies. This has shown to be particularly important in idiopathic stenosis. Another area of research is the role of the local airway microbiota. We have investigated the methods of mapping and control of the microbial biofilm contents of the silicone airway prosthesis to clarify whether this interacts with the local mucosa and impacts on the outcome of airway stenosis. Once the biofilm contents and its distribution are known, the next step is to create methods of control of the biofilm. We are currently focused on new strategies for the control of biofilm formation and fixation. I believe that the real challenge resides in the evolution of tracheal stenosis and its early diagnosis. When dyspnea and limitation of exercise capacity become clinically apparent, there is already a 70% reduction of the airway diameter by the stenosis, leading patients to seek medical attention late in the development of disease. Hypothetically, the application a of non-invasive outpatient diagnostic imaging and cytokine markers can potentially enable an early diagnosis and a timely treatment for patients with a recent history of intubation or tracheostomy. It requires the development of a model of tracheal stenosis that is currently under way in our research laboratory.
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. Cardoso: Our clinical research focuses on the predictors of complications after airway resection and the impact of gastroesophageal reflux (GER) in the pathogenesis and outcome of tracheal stenosis. In our series of tracheal resections, we found that comorbidities (O.R. 7.04), long segment resections above 40mm (O.R. 5.1) and re-resections (O.R. 49) were significant predictors of post-resection complications on multivariate analysis. Another interesting topic of investigation is the ominous effect of GER in patients with benign tracheal stenosis. In our series, patients with pathologic GER detected by esophageal pH study submitted to laparoscopic fundoplication sustained a 5-fold high chance of resolution of the stenosis in two years if compared to those treated with high dose proton pump inhibitors.
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. Cardoso: The two topics would be tissue engineering applied for airway diseases, and airway prosthesis for maintaining airway patency.
Reference
- Recent Developments in Benign Tracheal Stenosis. Available online: https://tcr.amegroups.org/post/view/recent-developments-in-benign-tracheal-stenosis