Fully robotic circumferential resection for midtracheal mucoepidermoid carcinoma: a report of 2 cases.

Background: Tracheobronchial mucoepidermoid carcinoma (MEC) is a salivary-gland type of lung cancer that originates from the submucosal glands of the tracheobronchial tree. MECs are rare, constituting 0.1% to 1.0% of lung carcinomas. Recent advancements in minimally invasive techniques allow for complete robotic resection of tracheal MECs. Case Description: Two cases are described in which patients underwent complete robotic thoracoscopic resection for the treatment of a tracheal MEC. Both patients, aged 14 and 28 years, with no significant medical history, presented with symptoms of hemoptysis and dyspnea on exertion. For both patients, spirometry revealed a flow volume loop indicative of intrathoracic central airway obstruction, computed tomography (CT) scans showed a midtracheal tumor and rigid bronchoscopy was performed for tumor debulking, confirming the pathological diagnosis of low-grade MEC. Multidisciplinary discussion led to the decision to proceed with primary surgical resection. In both cases, a circumferential tracheal resection with intrathoracic end-to-end anastomosis under veno-venous extracorporeal membrane oxygenation (VV-ECMO) was performed via a fully robotic approach. There were no intraoperative complications. One patient required re-intervention via open approach due to positive resection margins on paraffin-embedded sections despite a negative frozen section peroperatively. Both patients had an uncomplicated recovery with discharge on postoperative days 7 and 4, respectively. The 30-day follow-up showed normal flexible bronchoscopy. The patients had no evidence of recurrence at 5-year (patient 1) and 1-year (patient 2) follow-up. Conclusions: A fully robotic thoracoscopic approach for midtracheal tumor resection under VV-ECMO is feasible, pending negative margins. Peroperative flexible bronchoscopy is essential to mark the lesion after endotracheal debulking. Multidisciplinary discussion is essential in the decision-making process for the treatment of MEC.