Laryngology

Vol. 46: Issue 5 - October 2026

Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society

Authors

Cesare Piazza , Giorgio Peretti , Davide Lancini , Kishore Sandu , Marta Filauro , Jan Constantin Koelmel , Francesco Mattioli , Cecilia Molendi , Christoph Arens , Christian Sittel , Reza Nouraei

Keywords: tracheal resection, crico-tracheal resection, laryngo-tracheal resection, sleeve resection, end-to-end anastomosis, airway stenosis, laryngo-tracheal stenosis, classification
DOI: 10.14639/0392-100X-A2467
Publication Date: 2026-10-28

Summary

Objective. Tracheal (TRA) and crico-tracheal resection and anastomosis (CTRA) are highly effective surgical procedures for managing selected cases of laryngo-tracheal stenosis, although the absence of a standardised classification limits the use of a common language within the scientific community and hinders multicentre comparisons. We present the European Laryngological Society (ELS) proposal, categorising (C)TRA into 6 Types (A1, A2, B, C, D, and E) mainly based on their anatomical extension and type of anastomosis performed.
Methods. The classification was validated through a preliminary multicentre cohort of 390 patients treated between September 1996 and March 2026 in 4 European referral airway centres sharing a common protocol for definitions of (C)TRA. Primary outcomes included postoperative complications and airway patency in terms of tracheostomy-free rate.
Results. The cohort was distributed across (C)TRA Type A1 (24.9%), A2 (21%), B (19%), C (31%), D (1.5%), and E (2.6%). Overall and anastomosis-specific complication rates increased from Type A1 to Type C, reflecting the technical burden of the procedure, while planned temporary tracheotomy in Types D and E effectively mitigated acute airway morbidity. Long-term functional success remained high across all (C)TRA Types, with tracheostomy-free rates ranging from 95.1% to 100% for all different kinds of (C)TRA procedures.
Conclusions. The proposed ELS classification provides a standardised framework that correlates well with surgical complexity and complication profiles, enhancing data comparability and serving as a valuable didactic resource for the international airway community.

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Authors

Cesare Piazza - Unit of Otorhinolaryngology – Head and Neck Surgery, ASST – Spedali Civili of Brescia, Comprehensive Cancer Center,, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy

Giorgio Peretti - Unit of Otorhinolaryngology – Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, School of Medicine, Genoa, Italy

Davide Lancini - Unit of Otorhinolaryngology – Head and Neck Surgery, ASST – Spedali Civili of Brescia, Comprehensive Cancer Center,, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy

Kishore Sandu - Department of Otorhinolaryngology, University Hospital – CHUV, Lausanne, Switzerland

Marta Filauro - Unit of Otorhinolaryngology – Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, School of Medicine, Genoa, Italy

Jan Constantin Koelmel - Department of Otorhinolaryngology – Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany

Francesco Mattioli - Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital of Modena, Modena, Italy

Cecilia Molendi - Unit of Otorhinolaryngology – Head and Neck Surgery, ASST – Spedali Civili of Brescia, Comprehensive Cancer Center,, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy. Corresponding author - ceciliamolendi@gmail.com

Christoph Arens - Department of Otorhinolaryngology – Head and Neck Surgery, Medical Faculty, University of Giessen, Giessen, Germany

Christian Sittel - Department of Otorhinolaryngology – Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany

Reza Nouraei - The Loxley Centre for Airway, Voice and Swallowing, Department of Otorhinolaryngology, Nottingham University Hospitals NHS Trust, Nottingham, UK

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Copyright

Copyright (c) 2026 Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale

How to Cite
Piazza, C., Peretti, G., Lancini, D., Sandu, K., Filauro, M., Koelmel, J. C., Mattioli, F., Molendi, C., Arens, C., Sittel, C., & Nouraei, R. (2026). Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society. ACTA Otorhinolaryngologica Italica, 46(5), 367–373. https://doi.org/10.14639/0392-100X-A2467
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