Surgical outcomes and long-term prognosis of patients with tracheobronchial adenoid cystic carcinoma.

Tracheobronchial adenoid cystic carcinoma (ACC) is a rare malignant disease of the central airways. Complete resection is the primary goal for this tumor; however, it remains challenging due to the complexity of reconstruction, tumor submucosal spread, and the risk of dehiscence. Conversely, tracheobronchial ACC has relatively favorable long-term outcomes due to its indolent growth. Due to the rarity of this tumor, a clear treatment guideline has yet to be established. This study aimed to evaluate treatment strategies, perioperative outcomes, and long-term prognosis of tracheobronchial ACC cases at our institution to identify the optimal therapeutic strategy for this challenging disease. We retrospectively analyzed 11 patients who underwent surgical intervention for tracheobronchial ACC at our institution from 2000 to 2024. Clinical, surgical, and oncologic outcomes were assessed, including the impact of surgical margins and adjuvant therapy. Complete resection was achieved in two cases, while nine patients had positive margins requiring postoperative radiotherapy. No local recurrences were observed, but distant metastases occurred in 54.5% of cases. Oligometastatic disease was effectively managed with local therapy. The 5-year and 10-year overall survival rates were 90% and 75%, respectively. Surgical resection remains the cornerstone of treatment for tracheobronchial ACC, however achieving negative surgical margins is not always feasible. In such cases, postoperative radiotherapy is considered an effective strategy to mitigate the risk of local recurrence. Local treatment of oligometastatic disease may provide a survival. These results indicate the importance of a multimodal treatment approach tailored to the specific challenges of tracheobronchial ACC.