[Advances in tracheal surgery: are we close to finding the ideal tracheal substitute?].

Tracheal surgery has evolved progressively with advances in anaesthesia, the understanding of tracheal pathology and the efforts made by surgeons all over the world. In the era of organ transplantation, tracheal replacement remains an unsolved problem and one of the most important challenges in thoracic surgery. In animals, the use of a stent supported aortic graft as a tracheal substitute led to unexpected tissue regeneration in the form of a functional "neo-trachea" with respiratory epithelium and cartilage. These results led to the first clinical applications in France in patients with extensive, incurable, malignant tracheal tumors. Experimental and clinical research programs have to be increased in order, firstly to provide a standardized surgical technique for complex tracheal lesions and secondly to understand better the mechanisms of tracheal regeneration.