Management of malignant tracheobronchial stenoses with the use of airway stents.

BACKGROUND

Tracheobronchial stenoses caused by malignant etiologies are life-threatening with respiratory distress symptoms. Airway stent insertion is an effective method of relieving the airway obstruction. We report our experience with the use of Dumon silicone stents and self-expandable metallic Ultraflex stents.

METHODS

From July 1999 to December 2003, ten patients (7 men, 3 women) with a mean age of 56.3 years (range, 37 to 77 years) had stent insertion to manage their malignant airway stenoses. Underlying malignancies included 6 esophageal cancers, one NPC with mediastinal recurrence, 1 recurrent adenoid cystic carcinoma, 1 metastatic mediastinal lymphadenopathy and 1 mediastinal multiple myeloma. All patients had severe respiratory distress. All stents were placed through a rigid Efer-Dumon bronchoscope under general anesthesia.

RESULTS

Eight Dumon silicone stents (4 tracheal, 1 bronchial and 3 Y-shaped) were placed in 7 patients. Four metallic Ultraflex stents (2 tracheal and 2 bronchial) were placed in 3 patients. There was no death related to stent placement, and there were no immediate complications after stenting. Significant improvement of respiratory distress was seen in 9 patients (90%) after stenting. Three stent migrations occurred in 12 stent placements. During follow-up to the present time, 7 patients died of disease progression, with a median survival of 5.2 months (range, 1 to 17.8 months) after stenting. Two patients remain alive, with survivals of 49 and 12 months respectively.

CONCLUSIONS

The insertion of the airway stents, either Dumon silicone stents or metallic Ultraflex stents, can provide an effective method to immediately relieve respiratory distress, to improve the quality of life and to prolong survival in patients with malignant central airway stenoses.