key: cord-0975127-7xf9x92g
authors: Rendina, Erino Angelo; Maurizi, Giulio
title: Commentary: COVID-19 and the airway: How can surgery help?
date: 2020-09-28
journal: JTCVS Tech
DOI: 10.1016/j.xjtc.2020.09.026
sha: fd87b2342e39564c691b197c488430945860b55d
doc_id: 975127
cord_uid: 7xf9x92g

nan

We have read with interest the paper [1] from Dr. Lucchi and colleagues reporting on one 12 case of laryngotracheal resection for benign stenosis in a post Covid-19 patient; this is 13 certainly one of the first reports in this setting. The Pisa University team has done a very 14 good job in such a demanding condition. Moreover, this paper offers the opportunity to 15 learn more about the Covid-19 and the related airway diseases; also, it gives us 16 important insights about the role of surgery in this setting. 17

The first interesting aspect is that what the authors have described might be more and 18 more frequent over the next months or years. In fact, a large number of benign tracheal 19 stenosis is eventually expected because of the prolonged intubation and/or tracheostomy 20 performed to manage the severe respiratory impairment occurring in many Covid-19 21 patients. The authors reported the presence of a process of coagulative necrosis in the 22 tissue of the resected airway (documented at the pathological examination), thus 23 confirming the recently published literature that points out the systemic effect of the 24 Covid-19 which sometimes leads to a multi-organ involvement. Interestingly, the authors 25 did not report any additional technical difficulty related to this specific condition 26 compared to a laryngotracheal reconstruction performed in a standard situation.

[2] 27 Conversely, we experienced very hard and peculiar inflammatory tissues, still persisting 28 in the peritracheal area during the dissection and the following airway reconstruction 29 when we recently performed tracheal reconstruction with success in 4 patients who just 30 recovered from Sars-Cov2 (postintubation stenosis in 2 cases and tracheoesofageal fistula 31 in other 2 cases). These operations were all extremely technically demanding. Based on 32 this limited experience, we cannot provide conclusive recommendation. Nevertheless, 33 our convincement is that a study should be conducted in order to better investigate and 34 define the best timing for tracheal resection after Sars-Cov2 recovery. There is no doubt 35 that we are facing with a new disease causing a totally new set of disorders which must 36 still be fully understood. The Covid-19 will probably be a problem for a long time. 37

Surgery could definitely be helpful for many post-Covid-19, but at the right time and 38 with a very careful or cautious approach. An unpredictable scenario has happened, and 39 we have no other choice than learn with experience, in order to further define how 40 surgery can be helpful in patients who have or had Sars-Cov2. 41

We thank all our institution's women and men who tirelessly make patient's care 44 possible every day, even at this difficult Covid-19 pandemic time. 45 46 48

A COVID-19 PATIENT J