Forbearance with endobronchial stenting: cognisance before conviction

Advances in studies on tracheal stent design addressing the related complications

Tracheal stents can be used to quickly reconstruct the airway and relieve symptoms of dyspnea in patients with tracheal stenosis. However, existing tracheal stents lead to complications such as granulation tissue formation, difficulty in removal, persistent growth of malignant tumors, stent migration, and mucus plugging. In this article, we reviewed the main methods used to reduce complications associated with tracheal stent design. Drug-eluting stents can inhibit granulation tissue formation and prevent infection and local chemotherapy. The biodegradable stent can support the trachea for some time, maintain tracheal patency, and degrade gradually, which avoids removing or replacing the stent. Radioactive stents loaded with I125 have good potential for inhibiting the persistent growth of malignant tumors. Three-dimensional printing technology enables the manufacturing of patient-specific stents, which increases the degree of matching between the complex tracheal anatomy and the stent, thus providing a new solution for stent migration caused by structural mismatch. Minimizing the barrier of the stent to mucociliary clearance, providing an anti-fouling coating, and culturing respiratory epithelial cells on the surface of the stent are the main methods used to reduce mucus plugging. We also proposed future research directions for tracheal stents to guide the design and manufacture of ideal tracheal stents.

Advanced Squamous Cell Carcinoma in the Paratracheal Region: Navigating Diagnosis and Comprehensive Treatment Challenges

This case of a paratracheal mass emphasizes the importance of early detection and flexibility in the treatment planning for advanced squamous cell carcinoma, especially when logistical challenges impact access to care. A 69-year-old woman presented with a four-month history of progressive dysphagia, significant weight loss, and the recent onset of stridor, suggesting potential airway obstruction. Imaging studies revealed a large heterogeneous mass in the superior mediastinum, extending from the base of the neck into the thoracic inlet. The mass measured approximately 6.9 cm × 3.4 cm, involving the trachea and upper esophagus, causing significant compression and deviation. Additional findings included small hypermetabolic lymph nodes in the mediastinum. The patient underwent bronchoscopy and endoscopy, which revealed narrowing but no intraluminal lesions, indicating external compression by the mass. The pathological examination confirmed well-differentiated squamous cell carcinoma, characterized by keratinization and positive p40 immunostaining, with negative p16 immunostaining, indicating a non-HPV-related etiology. An urgent tracheostomy was performed to secure the airway, which the patient tolerated well. Following this, inpatient chemotherapy with a regimen of Taxotere, Cisplatin, and 5-fluorouracil (TPF) was initiated to manage the tumor and prevent further complications. This case required a multidisciplinary approach to address the patient's complex clinical presentation, including surgical, oncological, and supportive care. As confirmed by imaging, the lack of distant metastasis suggests a potentially better prognosis if effective local control can be achieved. The integrated care provided was essential in managing the patient's immediate and long-term health needs.

Interventional bronchoscopy in lung cancer treatment

Interventional bronchoscopy has seen significant advancements in recent decades, particularly in the context of lung cancer. This method has expanded not only diagnostic capabilities but also therapeutic options. In this article, we will outline various therapeutic approaches employed through either a rigid or flexible bronchoscope in multimodal lung cancer treatment. A pivotal focus lies in addressing central airway obstruction resulting from cancer. We will delve into the treatment of initial malignant changes in central airways and explore the rapidly evolving domain of early peripheral malignant lesions, increasingly discovered incidentally or through lung cancer screening programmes. A successful interventional bronchoscopic procedure not only alleviates severe symptoms but also enhances the patient's functional status, paving the way for subsequent multimodal treatments and thereby extending the possibilities for survival. Interventional bronchoscopy proves effective in treating initial cancerous changes in patients unsuitable for surgical or other aggressive treatments due to accompanying diseases. The key advantage of interventional bronchoscopy lies in its minimal invasiveness, effectiveness and favourable safety profile.

Pulmonary adenoid cystic carcinoma - a spectrum of disease: two case reports

Adenoid cystic carcinoma (ACC) is a rare form of adenocarcinoma that usually begins in the oral cavity, with most cases arising from the salivary glands. Owing to its low incidence, the precise clinical and pathological features, including therapeutic strategy and survival data have not been conclusively reported. ACCs are typically characterized by slow growth, perineural invasion with local and often late recurrence after initial diagnosis. However, some cases demonstrate unusual aggressive biologic behaviour. Herein we describe our experience of two patients with a diagnosis of ACC. These cases highlight the spectrum of the disease with individualized treatment strategies.

A prediction model for risk of low oxygen saturation in patients with post-tuberculosis tracheobronchial stenosis during bronchoscopy

BACKGROUND

Low oxygen saturation (LOS) is a frequent occurrence for patients with post-tuberculosis tracheobronchial stenosis (PTTS) during bronchoscopic procedures. However, there are currently no systematic assessment tools to predict LOS risk in PTTS patients during bronchoscopy.

OBJECTIVES

This study aimed to develop an effective preoperative predictive model to guide clinical practice.

DESIGN

Retrospective cohort study.

METHODS

Data was retrospectively collected from PTTS patients who underwent bronchoscopic interventions between January 2017 and December 2022. Among all patients included in this study, patients between January 2017 and December 2021 were used as training cohort for the logistic regression model, and patients between January 2022 and December 2022 were utilized as validation cohort for internal validation. We used consistency index (C-index), goodness-of-fit test and calibration plot to evaluate the model performance.

RESULTS

A total of 465 patients who met the inclusion criteria were enrolled in the study. The overall incidence of LOS was 26.0% (121/465). Comorbidity, degree of stenosis, bronchoscopist level, thermal ablation therapy, balloon dilation, and airway stenting, as independent risk factors for the presence of LOS, were used to construct the nomogram prediction model. The C-index of training cohort was 0.827 (95% CI, 0.786-0.869), whereas that of validation cohort was 0.836 (95% CI, 0.757-0.916), combining with the results of the calibration plot and goodness-of-fit test, demonstrating that this model had good predictive ability.

CONCLUSION

The predictive model and derived nomogram with good predictive ability has been developed to preoperatively predict the risk of LOS in PTTS patients during bronchoscopy, allowing for individualized interventions for high-risk patients.