Clinical Outcomes with Airway Stents for Proximal versus Distal Malignant Tracheobronchial Obstructions

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PURPOSE

This study evaluates the outcome of tracheobronchial stent placement in symptomatic patients with malignant disease.

MATERIALS AND METHODS

From 1993 to 2002, 30 patients had stents placed for malignant strictures. Five of 30 patients underwent stent placement distal to the mainstem bronchi, 13 received stents in both the proximal and distal airways, and 12 received stents in only the proximal airways. Clinical response and survival were determined from the patients' medical records. A positive clinical response was judged to have occurred if the patient improved in two of these three categories: subjective symptoms (patient-reported), objective signs (clinician-reported), and postprocedural imaging.

RESULTS

The condition of 29 of 30 patients improved within 4 weeks of stent placement. The mean survival duration after stent placement was 261 days (SD, 395.1 days). The location of stent placement was not associated with significant differences in clinical improvement or survival (P = .51). Eight patients had additional airway segments that were too diffusely involved in which to place a stent or could not be recanalized. Mean survival in this group with incomplete stent placement was significantly reduced at 24.9 days (SD, 23.1 days), compared with 345.5 days (SD, 436 days) for the remaining patients who underwent complete stent placement (P < .05). Four patients lived less than 10 days after the procedure and three patients (75%) had mediastinal invasion.

CONCLUSION

Tracheobronchial stent placement effectively palliates malignant airway obstruction, and clinical improvement is independent of the location in which the stent is implanted. When patients had diffuse or highly obstructive airway involvement and underwent incomplete stent placement, clinical response was also satisfactory, even though survival was worse. Patients with mediastinal invasion were poor candidates for stent placement as a result of their short survival.

Section snippets

Patient Population

Over a 9-year period (1993–2002), 50 patients underwent endobronchial stent procedures at our institution. Thirty-three procedures in 30 patients were performed for malignant airway disease. Institutional review board approval was granted for a retrospective review of this study population composed of 19 men and 11 women with an age range of 38 – 87 years (mean, 59 years). Indications for stent placement were dyspnea/respiratory distress in 27 patients and refractory postobstructive pneumonitis

RESULTS

Twenty-nine of 30 patients (97%) showed an improvement in at least two of three categories after stent placement. One patient did not show improvement after bronchial stent placement and survived only 29 days after the procedure.

Ten patients (33%) showed radiographic improvement, with clearing of infiltrates and improved lung expansion by CT or chest radiography. After airway stent placement, all bronchograms and/or bronchoscopy showed patent stent-implanted segments without residual narrowing.

DISCUSSION

Bronchogenic and esophageal carcinoma are the most frequent causes of MTS, which can result in serious patient morbidity resulting from dyspnea, hemoptysis, or unrelenting obstructive pneumonitis. For good surgical candidates, the treatment of choice remains lobectomy or pneumonectomy. However, patients with advanced thoracic malignancies often have symptomatic tracheobronchial obstruction. External-beam and/or endobronchial radiation therapy is another option for patients with MTS, with some

CONCLUSIONS

A majority (>90%) of patients with MTS show clinical and subjective improvement after tracheobronchial stent placement. However, only one third show immediate postprocedural radiographic improvement, and approximately 10% of patients will experience significant delay (1–2 weeks) before their dyspnea subsides. Clinical response is independent of airway stent location, and distal airway stents provide the same relief of dyspnea and similar survival time as proximal stents. Accordingly,

Acknowledgment

The authors thank Vicki McDowell for her time and effort in preparing this manuscript.

REFERENCES (15)

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None of the authors have identified a conflict of interest.

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