Chest
Volume 126, Issue 3, September 2004, Pages 951-958
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Bronchoscopy
Use of the Dumon Y-stent in the Management of Malignant Disease Involving the Carina: A Retrospective Review of 86 Patients

https://doi.org/10.1378/chest.126.3.951Get rights and content

Objective:

To study the efficacy of symptom relief and the safety of the Dumon Y-stent for central airway obstruction in malignant main carinal involvement and in malignant tracheoesophageal fistulas.

Design:

A retrospective review.

Setting:

Thoracic endoscopy referral center.

Patients and methods:

The medical records of 86 patients who had undergone the placement of a Dumon Y-stent at our institution were reviewed and analyzed.

Results:

Ninety Dumon Y-stents were placed in 86 patients to relieve symptoms of dyspnea, cough, and/or hemoptysis. Four of these patients required removal of that stent and replacement with a longer Dumon Y-stent due to tumor progression. There were only two instances of procedure-related adverse effects, which included coughing following stent placement lasting 1 week in one patient and stent migration in another patient. In the case of stent migration, the stent required immediate removal, and the patient experienced no adverse consequences. The remaining patients tolerated the stent well, and all experienced subjective symptomatic relief. There were no stent-related deaths. The average duration of a stent after placement was 133 days. The median time of survival following stent insertion was 181 days. Forty-five percent of all patients died at 3 months, and 72% died at 6 months.

Conclusion:

The Dumon Y-stent proved to be useful and was well-tolerated in the management of malignant disease involving the main carina. It also provided successful palliation in patients with malignant tracheoesophageal fistulas.

Section snippets

Materials and Methods

All patients undergoing the placement of a Dumon Y-stent at our interventional endoscopy unit were included in this retrospective study. All stents were placed in patients between July 1, 1994, and April 30, 2002, for malignant disease involving the main carina or because of a tracheoesophageal fistula. The aim of this study was to assess the palliative efficacy and safety of the Dumon Y-stent.

The patients presented to our service with respiratory symptoms of dyspnea, cough, and/or hemoptysis.

Results

Eighty-six patients (75 men and 11 women) with a median age of 60.4 years were included in this retrospective study (Table 2). Sixty percent of patients had primary tracheobronchial malignancies. Thirty-six percent had esophageal cancer, and 3.5% had metastatic disease (Table 3). Non-small cell lung cancer was the most frequently occurring tumor, accounting for 46.6% of cases (Table 3).

The most common indication for Y-stent placement (Table 4) was isolated tracheobronchial obstruction in 53.4%

Discussion

The optimal endoscopic management of tumors involving the main carina should be minimally invasive and should allow for the long-term control of potentially life-threatening tracheobronchial obstructions. It should also be applicable to a majority of patients, among them those deemed inoperable.9 Patient age and prognosis should not be considered absolute contraindications to what is essentially palliative minimally invasive care. In selected patients with tracheobronchial obstructions and

Conclusion

In advanced malignant airway disease, survival is poor, and quality of life is limited by recurrent dyspnea, cough, and hemoptysis. In our experience, the Dumon silicone Y-stent provides a minimally invasive, safe, and effective palliative treatment for patients with malignant obstruction of the central airways. The advantages of the Dumon Y-stent include ease of placement and removal. Based on our experience, we suggest an algorithmic approach to the placement of the silicone Y-stent for

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This research was supported by Novatech.

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