Chest
Volume 104, Issue 6, December 1993, Pages 1653-1659
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Clinical Investigations: Journal Article
Silicone Stents in the Management of Inoperable Tracheobronchial Stenoses: Indications and Limitations

https://doi.org/10.1378/chest.104.6.1653Get rights and content

Background

Various stent models have been developed for the treatment of inoperable stenoses of the central airways caused by external compression. Increasing use is made of the silicone stents designed by Dumon. We tested their technical feasibility, tolerance, and long-term efficacy in relieving respiratory symptoms in patients referred for endoscopic palliation of malignant disease.

Methods

All procedures were performed under general anesthesia with the use of the rigid bronchoscope. We inserted 38 stents in 31 patients (median age, 67 years; 25 men and 6 women) whose airways showed residual obstruction of >50 percent of the lumen after laser resection of endobronchial tumor and/or mechanical dilatation of extrinsic compressions.

Results

Stent placement and removal—where necessary—were easy in all patients, but five stents inserted in three patients with short (≤2.5 cm) and conical stenoses migrated, necessitating emergency removal. In 27 of the remaining 28 patients, stent tolerance was excellent; 1 proximal tracheal stent (<1 cm below the vocal cords) had to he removed because of otalgia and dysphagia. One lethal hemoptysis occurred within hours after a repeated laser therapy and removal of an indwelling stent. No other serious complications occurred. Immediate and lasting relief of dyspnea and improvement in performance status (Karnofsky scale, activity index) was achieved in 90 percent (28/31) of patients (p<0.01). The influence of adjuvant radiotherapy on local tumor recurrence and survival was analyzed in a subgroup of ten patients with stage IIIB squamous cell carcinoma with comparable performance status. Five did not undergo adjuvant radiotherapy (group A) and five did (group B). In group A, four of five stents were occluded by tumor recurrence above or below the stent after a median follow-up of 2 months; in group B, zero of five were occluded (p<0.05) after 4 months. Median survival was 4 months in group A and 6 months in group B; the difference did not reach significance.

Conclusions

The silicone stents designed by Dumon are easily inserted and removed; they are also well tolerated and very efficacious in relieving respiratory symptoms caused by extrinsic airway compression. Short and conical stenoses present limitations for their use due to increased risk of migration. Combined treatment with laser resection, stent insertion, and subsequent radiotherapy is necessary to prevent local tumor recurrence and may improve survival.

Section snippets

Patients

Over a 2-year period, 91 patients (68 men, 23 women) with a median age of 65 years (range, 28 to 85 years) were referred to our units for investigation and treatment of inoperable central airway stenoses. Eighty-nine patients suffered from advanced malignant disease, and 2 had external compression of a main bronchus caused by benign disease (1 aortic aneurysm, 1 complex deformity of thoracic spine). All patients were first examined by fiberoptic bronchoscopy under local anesthesia to assess the

Insertion Technique and Position of Stents

A total of 38 silicone stents were inserted in the 31 patients. Two patients received two stents simultaneously; one patient with an esophagotracheal fistula received a tracheal and an esophageal stent (Nottingham) and five patients needed stent replacement because of migration or local tumor recurrence. In 42 percent (13/31) of patients, stent insertion was performed as an emergency procedure because of life-threatening tracheobronchial obstruction. The insertion of all stents proved to be

DISCUSSION

Since the first description of his tracheobronchial stent by Dumon,3 the use of these silicone endoprostheses has gained increasing popularity. At our institution, we opted for this stent mainly because of patients' acceptance of a device that was removable. The results in our 31 patients confirmed the ease of insertion and removal of these stents. The fact that they can be fine adjusted with a forceps once they are already deployed presents a clear advantage over other stent types such as the

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