Self-expanding metallic stent placement for the palliation of malignant airway complications.

Abstract

Background: Tracheal stenosis and fistula are critical conditions with severe symptoms necessitating prompt intervention, making tracheal stent insertion a suitable treatment option. This study aimed to describe the efficacy of tracheal stenting using a less invasive flexible bronchoscope for malignant tumors.

Methods: Medical records at Chiba University Hospital from January 2008 to December 2021 were retrospectively examined. During this period, 76 stents were placed in 63 patients. Thirteen patients who underwent tracheal self-expanding metallic stent (SEMS) via flexible bronchoscopy to alleviate palliative symptoms due to malignancy were investigated for clinical outcomes.

Results: The cohort comprised 11 men and two women, and the mean age was 68.7 (range, 60-82) years. Pathologic diagnosis was esophageal cancer in 10 patients, lung cancer in two, and colon cancer in one. Indications for stent insertion were stenosis in six patients, fistulas to neighboring structures in five, and both in two. All patients exhibited airway symptoms, including cough, dyspnea, or pneumonia, and 7 (53.8%) had >50% stenosis on the computed tomography (CT) image. Ultraflex/AERO stents were used in 11/2 patients; the location of insertion was the trachea in 11 patients and both the trachea and bronchus in two. The mean time from stent indication to insertion was 3.6 (range, 0-11) days. Severe complications included membranous tracheal injury, hemoptysis, pneumonia, mediastinitis, and restenosis. Oxygen demand or symptoms improved within 1 week after the procedure in 10 (76.9%) patients. Overall, 10 (76.9%) patients were discharged or transferred to another hospital, while the other 3 (23.1%) died in the hospital without discharge or transfer. Additional chemotherapy was administered to 6 (46.2%) patients. The overall median survival time was 75 days, with a significantly better prognosis observed in 10 patients with symptomatic improvement (107 vs. 3 days, P=0.02) and six eligible for chemotherapy (204 vs. 22 days, P=0.01).

Conclusions: Minimally invasive tracheal stenting using flexible bronchoscopy for malignancy is effective in patients who have undergone tracheal SEMS placement. The prognosis was notably better in patients with symptomatic improvement, particularly when chemotherapy was administered after stenting.