Transcriptomic Profile Changes: CO2 Laser Wedge Resection vs Radial Incision for Benign Tracheal Stenosis

Benign tracheal stenosis (BTS) is a rare but serious condition where the airway narrows due to scarring from causes like post-intubation or tracheostomy. The standard treatment involves bronchoscopic procedures, but recurrence rates are high and the best technique is uncertain. This study focuses on two common methods: carbon dioxide (CO₂) laser wedge resection and radial incision with dilation. While there's some evidence that wedge resection may have lower recurrence rates and longer recurrence-free intervals, the reasons behind this aren't fully understood. This research involves a randomized pilot study with 40 BTS patients, comparing the two methods. Before and one month after the procedure, endobronchial biopsies are collected and analyzed using bulk ribonucleic acid (RNA) sequencing and spatial transcriptomics. This dual approach helps map molecular pathways related to fibrosis resolution, immune cell dynamics, and epithelial repair. Patients are monitored for two years with standard clinical, physiologic, and imaging assessments. The molecular findings are then linked with recurrence-free survival and other significant outcomes. The aim is to fill critical knowledge gaps in understanding BTS management, potentially improving treatment selection and identifying new therapeutic targets to prevent recurrence.