Evaluating long-term bronchoscopic outcomes of tracheobronchoplasty in patients with expiratory central airway collapse.

Background: Expiratory central airway collapse (ECAC) is characterized by symptoms of respiratory mechanical outflow obstruction. Open and robotic tracheobronchoplasty (TBP) are the preferred surgical approaches for severe cases. However, more studies are needed to compare their long-term outcomes. Here we evaluated changes after TBP. Methods: This retrospective cohort included patients with ECAC who underwent TBP. We evaluated patients with dynamic bronchoscopy, pulmonary function, and six-minute walk tests (6MWT) before and after surgery. We used the ECAC severity score to assess airway collapse, with nine indicating severity. We used descriptive statistics to explore associations between variables and linear mixed models to assess changes over time and to examine associations between variables and outcomes. Results: The study included 61 patients, the majority of whom were female (69%), with a median age of 63 years. Most patients underwent open TBP (n=33, 54%). Baseline characteristics were similar between surgical approaches. Patients who underwent open TBP improved the ECAC severity score from baseline to 1 year after surgery, with scores decreasing from 10.79 to 0.83 for the open approach and from 10.69 to 0.73 for the robotic approach. The two surgical techniques had no significant differences in this outcome (P=0.89). Pulmonary function tests remained stable over time, while the 6MWT showed a mean improvement of 76 m from baseline to 2 years post-surgery, regardless of the approach used. Conclusions: Both open and robotic TBP are effective treatment options for patients with ECAC, as they stabilize the central airways and improve long-term functional outcomes.