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Lilburn P, Williamson JP, Phillips M, Tillekeratne N, Ing A, Glanville A, Saghaie T. Tracheobronchial stents: an expanding prospect. Intern Med J 2024; 54:204-213. [PMID: 38140778 DOI: 10.1111/imj.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
The first dedicated tracheobronchial silicone stent was designed by the French pulmonologist Jean-Paul Dumon. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistulae. Silicone stents require rigid bronchoscopy for insertion; however, they are more readily repositioned and removed compared with metallic stents. Metallic stents demonstrate luminal narrowing when loads are applied to their ends, therefore stents should either be reinforced at the ends or exceed the area of stenosis by a minimum of 5 mm. Nitinol, a nickel-titanium metal alloy, is currently the preferred material used for airway stents. Airway stenting provides effective palliation for patients with severe symptomatic obstruction. Drug-eluting and three-dimensional printing of airway stents present promising solutions to the challenges of the physical and anatomical constraints of the tracheobronchial tree. Biodegradable stents could also be a solution for the treatment of nonmalignant airway obstruction.
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Affiliation(s)
- Paul Lilburn
- Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin Phillips
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nikela Tillekeratne
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Alvin Ing
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Allan Glanville
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tajalli Saghaie
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Dual Airway and Esophageal Stenting in Advanced Esophageal Cancer With Lesions Near Carina. J Bronchology Interv Pulmonol 2021; 27:286-293. [PMID: 32966034 DOI: 10.1097/lbr.0000000000000672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tracheobronchial stenting either alone or with esophageal stenting is often required for symptom palliation in obstructive or fistulous lesions of the airway due to esophageal cancer. There is limited evidence regarding dual stenting for lesions near the carina due to esophageal cancer. Hence, this study aims to evaluate the technical feasibility, outcomes, and complications of preplanned dual stenting in these patients. METHODS This is a prospective observational study carried out over a period of 4 years (January 2015 to July 2019). All patients undergoing dual stenting in the airway and esophagus with obstructive or fistulous lesions near the carina were included. The esophageal stent was placed within 24 hours. Prestenting and poststenting symptoms were compared using a symptom-based visual analog scale, Hugh Jones dyspnea scale and dysphagia scale. RESULTS Twenty-nine patients (20 males; mean±SD age, 55.3±12.2 y) underwent dual stenting. Twenty-four patients had central airway obstruction due to: infiltration in 20 (69%) and external compression in 4 (13.7%), respectively. Five (17.3%) patients had tracheoesophageal fistula with no airway obstruction. In 80% of the patients (n=23), silicone stents were placed. There was significant improvement in both dyspnea and dysphagia after dual stenting (P<0.001). Mucus plugging, lower respiratory infection, and granulation tissue were the main complications. Median survival after dual stent was 97 days (range, 17 to 297 d). CONCLUSION Dual stenting within the airway and the esophagus is a safe and viable option for palliative relief of symptoms in patients with advanced esophageal cancer.
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Chen Y, Zhou ZQ, Feng JX, Su ZQ, Zhong CH, Lu LY, Chen XB, Tang CL, Digumarthy SR, Fiorelli A, Natour E, Lococo F, Petrella F, Harris K, Nakada T, Zhong NS, Li SY. Hybrid stenting with silicone Y stents and metallic stents in the management of severe malignant airway stenosis and fistulas. Transl Lung Cancer Res 2021; 10:2218-2228. [PMID: 34164271 PMCID: PMC8182715 DOI: 10.21037/tlcr-21-353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Airway stenting is frequently used in the palliative treatment of patients with advanced tumor-induced airway stenosis and fistulas. However, there is paucity of studies regarding the use of airway stents in restoring patency. The aim of the study was to assess the efficacy and safety of hybrid silicon Y stents and covered self-expanding metal stents (SEMS) and in reestablishing patency in airway stenoses and fistulas. Methods This retrospective study included 31 patients between January 2016 to December 2019 with inoperable complex malignant airway stenoses and fistulas, managed with Silicone Y stents, and covered SEMS. The clinical details, clinical outcomes and complications up to 6 months were extracted from medical records. The improvement of performance was assessed based on modified British Medical Research Council (mMRC) dyspnea scores (t=6.892, P<0.001), Karnofsky Performance Scores (KPS) (t=-11.653, P<0.001), and performance status (PS) (t=3.503, P<0.001). Result A total of 31 silicon Y stents and 35 covered SEMSs were inserted. Of the 31 patients (M:F 20:11; age: 54.64±9.57), 25/31 (80.6%) experienced immediate relief of symptoms following stent placement. Patients' mMRC dyspnea scores, KPS, and PS showed significant improvement following stenting. The mean duration of stent placement was 146.3±47.7 days, and 17/31 (55%) patients were alive at 6 months. No major complications related to hybrid stenting were observed during the follow-up period. Conclusions Hybrid stenting is a feasible and safe palliative treatment for malignant airway stenosis and fistulas to improve quality of life and can be performed without major complications.
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Affiliation(s)
- Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zi-Qing Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jia-Xin Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhu-Quan Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chang-Hao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Ya Lu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Bo Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chun-Li Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Subba R Digumarthy
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Universitàdella Campania Luigi Vanvitelli, Naples, Italy
| | - Ehsan Natour
- University Medical Center of RWTH-Aachen, Aachen, Germany.,University Medical Center Maastricht, Department of Cardiothoracic Surgery, Maastricht, The Netherlands
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Kassem Harris
- Department of Medicine, Division of Pulmonary Critical Care, Interventional Pulmonology Section, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Takeo Nakada
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shi-Yue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Chen Y, Zhou Z, Feng J, Zhong C, Lu L, Chen X, Tang C, Li S. [Use of Hybrid Stent in Management of Complex Malignant Airway Stenosisand Fistulas]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:472-478. [PMID: 32517452 PMCID: PMC7309543 DOI: 10.3779/j.issn.1009-3419.2020.104.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
背景与目的 气道内支架广泛应用于气管狭窄和气管瘘的治疗,但使用气道内支架重建复杂气道的临床数据仍不充足。硅酮支架杂交金属支架重建复杂气道的有效性和安全性。 方法 纳入无法手术的复杂恶性气道狭窄和气道瘘患者。使用Y型硅酮支架联合金属覆膜支架(杂交支架)重建气道。评价置入支架后6个月的疗效和并发症。 结果 共纳入23例患者,置入23枚Y型硅酮支架和25枚金属覆膜支架。19例患者(19/23, 82.6%)置入支架后症状迅速缓解。支架平均置入(153.43±9.14)d。置入支架后改良呼吸困难指数(modified British Medical Research Council, mMRC)、卡氏功能状态(Karnofsky performance status, KPS)评分和功能状态(performance status, PS)评分显著改善。12例患者带支架生存超过6个月。其余患者肿瘤进展导致6个月内死亡。无支架置入相关死亡及严重并发症。 结论 杂交支架重建恶性复杂气道疗效确切,耐受良好。
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Affiliation(s)
- Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Ziqing Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jiaxin Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Changhao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Liya Lu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaobo Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Chunli Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Serino M, Freitas C, Saleiro S, Cabrita B, Conde M, Fernandes MGO, Magalhães A. Airway stents in malignant central airway obstruction. Pulmonology 2021; 27:466-469. [PMID: 33744216 DOI: 10.1016/j.pulmoe.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- M Serino
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - C Freitas
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - S Saleiro
- Pulmonology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - B Cabrita
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - M Conde
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - M G O Fernandes
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - A Magalhães
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
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A Prospective Outcome Assessment After Bronchoscopic Interventions for Malignant Central Airway Obstruction. J Bronchology Interv Pulmonol 2020; 27:95-105. [PMID: 31567627 DOI: 10.1097/lbr.0000000000000624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A systematic assessment of comprehensive clinical outcomes after various therapeutic procedures for malignant central airway obstruction (CAO) is lacking. METHODS Patients with symptomatic malignant CAO undergoing various therapeutic bronchoscopy procedures were assessed for symptomatic and functional improvement using the Speiser Score, spirometry, 6-minute walk distance (6MWD), and St. George Respiratory Questionnaire (SGRQ) up to 3 months after the procedures. RESULTS A total of 83 intervention procedures were performed in 65 patients, comprising 43 (66.2%) male individuals [overall mean age, 52.4; SD, 15.4 y]. The majority of these (92.3%) was done using rigid bronchoscope under general anesthesia. Airway stenting was the most common intervention performed (56.6%), followed by mechanical debulking (26.5%), cryodebulking (6%), electrosurgical removal (4.8%), balloon dilatation (3.6%), and laser ablation (2.4%).A total of 15 complications (18.1%) were noted. Of these, 8 (53.3%) were early complications and 7 (46.7%) were late complications. Early complications included airway bleeding, hypoxia, vocal cord injury, laryngeal injury, and pneumothorax. Late complications included significant granulation tissue formation in metallic stents and lung collapse because of mucus plug.The survival rates at 4, 8, and 12 weeks were 83%, 70.7%, and 66.1%, respectively. Significant improvement was observed in dyspnea, cough, Speiser Score, 6MWD, forced expiratory volume in 1 s, forced vital capacity, and SGRQ scores at 48 hours, 4 weeks, and at 12 weeks after the procedures and no procedure-related mortality occurred. CONCLUSION Various therapeutic bronchoscopic interventions, including combined modalities, provide rapid and sustained improvements in symptoms, respiratory status, exercise capacity, and quality of life in malignant CAO and have a good safety profile.
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Dutau H, Di Palma F, Thibout Y, Febvre M, Cellerin L, Naudin F, Hermant C, Vallerand H, Lachkar S, Fournier C, Laroumagne S, Quiot JJ, Vergnon JM. Impact of Silicone Stent Placement in Symptomatic Airway Obstruction due to Non-Small Cell Lung Cancer – A French Multicenter Randomized Controlled Study: The SPOC Trial. Respiration 2020; 99:344-352. [DOI: 10.1159/000506601] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/16/2020] [Indexed: 11/19/2022] Open
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Aboudara M, Rickman O, Maldonado F. Therapeutic Bronchoscopic Techniques Available to the Pulmonologist: Emerging Therapies in the Treatment of Peripheral Lung Lesions and Endobronchial Tumors. Clin Chest Med 2020; 41:145-160. [PMID: 32008626 DOI: 10.1016/j.ccm.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Therapeutic bronchoscopy for both endobronchial tumors and peripheral lung cancer is rapidly evolving. The expected increase in early stage lung cancer detection and significant improvement in near real-time imaging for diagnostic bronchoscopy has led to the development of bronchoscopy-delivered ablative technologies. Therapies targeting obstructing central airway tumors for palliation and as a method of local disease control, patient selection and patient-centered outcomes have been areas of ongoing research. This review focuses on patient selection when considering therapeutic bronchoscopy and new and developing technologies for endobronchial tumors and reviews the status of bronchoscopy-delivered ablative tools for peripheral lung cancers.
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Affiliation(s)
- Matt Aboudara
- Division of Pulmonary and Critical Care, St. Luke's Health System, 4321 Washington Street, Suite 6000, Kansas City, MO 64111, USA
| | - Otis Rickman
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, 1161 21st Avenue South, T-1218 Medical Center North, Nashville, TN 37232, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, 1161 21st Avenue South, T-1218 Medical Center North, Nashville, TN 37232, USA.
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Pandit A, Gupta N, Kumar V, Bharati SJ, Garg R, Madan K, Mishra S, Bhatnagar S. Effect of Palliative Bronchoscopic Interventions on Symptom Burden in Patients with Central Airway Narrowing: A Retrospective Review. Indian J Palliat Care 2019; 25:250-253. [PMID: 31114112 PMCID: PMC6504744 DOI: 10.4103/ijpc.ijpc_165_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Early integration of palliative interventions in patients with central airway obstruction (CAO) has shown to reduce patients' distress due to breathlessness and achieve better outcomes at lower cost. This retrospective review was performed to determine whether rigid bronchoscopic interventions alleviated the symptom burden and the requirement for continued mechanical ventilation in patients with CAO in a tertiary care hospital. MATERIALS AND METHODS Detailed records of 105 patients with CAO were retrospectively studied. The Numerical Rating Scale (NRS) score for cough and dyspnea before and after the intervention was noted. A need for an escalation or reduction in level of care was also noted. RESULTS The mean NRS score for dyspnea (n = 84) reduced from 7.5 (4-9) (before procedure) to 2.5 (2-6) after intervention (P < 0.01). The mean NRS score for cough (n = 68) also reduced from 6.5 (4-8) (before procedure) to 4 (3-7) after intervention (P < 0.01). Of these patients, bronchoscopic intervention allowed transfer out of the ICU in 14 patients (42%) and immediate withdrawal of mechanical ventilation in 8 patients (42%). CONCLUSION There is an instantaneous valuable palliation of symptoms and improved health-care utilization with airway tumor debulking and stenting. Multidisciplinary interventions with emphasis delivery of palliative care provide better care of patients with CAO.
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Affiliation(s)
- Anuja Pandit
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Dr. Nishkarsh Gupta, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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11
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Oki M, Saka H. Airway stenting for patients with airway stenosis because of small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2018; 12:2257-2263. [DOI: 10.1111/crj.12901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/28/2018] [Accepted: 04/08/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine; Nagoya Medical Center; Nagoya Japan
| | - Hideo Saka
- Department of Respiratory Medicine; Nagoya Medical Center; Nagoya Japan
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12
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Verma A, Goh SK, Tai DYH, Kor AC, Soo CI, Seow DGF, Sein ZNN, Samol J, Chopra A, Abisheganaden J. Outcome of advanced lung cancer with central airway obstruction versus without central airway obstruction. ERJ Open Res 2018; 4:00173-2017. [PMID: 29637076 PMCID: PMC5890022 DOI: 10.1183/23120541.00173-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/22/2018] [Indexed: 12/25/2022] Open
Abstract
Patients with central airway obstruction (CAO) from advanced lung cancer present with significant morbidity and are assumed to have lower survival. Hence, they are offered only palliative support. We asked if patients who have advanced lung cancer with CAO (recanalised and treated) will behave similarly to those with advanced lung cancer without CAO. This study was a retrospective review of the medical records of the patients managed for advanced lung cancer during 2010 and 2015 at our institution. 85 patients were studied. Median survival and 1-, 2- and 5-year survival were 5.8 months, 30.3%, 11.7% and 2.3% versus 9.3 months, 35.7%, 9.6% and 4.7%, respectively, in the CAO and no CAO groups (p=0.30). More patients presented with respiratory failure (15 (35%) versus none; p=0.0001) and required assisted mechanical ventilation (10 (23.3%) versus none; p=0.001) in the CAO group compared with the no CAO group. Fewer patients received chemotherapy in the CAO group (11 (25.5%)) compared with the no CAO group (23 (54.7%); p=0.008). There was no difference in survival among patients with advanced lung cancer whether they presented with CAO or without CAO. Survival was similar to those without CAO in patients with recanalised CAO despite greater morbidity and lesser use of chemotherapy, strongly advocating bronchoscopic recanalisation of CAO. These findings dispel the nihilism associated with such cases.
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Affiliation(s)
- Akash Verma
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Soon Keng Goh
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Dessmon Y H Tai
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Ai Ching Kor
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Chun Ian Soo
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Debra G F Seow
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Zin Nge Nge Sein
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Jens Samol
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Akhil Chopra
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - John Abisheganaden
- Dept of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
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Flannery A, Daneshvar C, Dutau H, Breen D. The Art of Rigid Bronchoscopy and Airway Stenting. Clin Chest Med 2018; 39:149-167. [DOI: 10.1016/j.ccm.2017.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Matsumoto K, Yamasaki N, Tsuchiya T, Miyazaki T, Kamohara R, Hatachi G, Nagayasu T. Double stenting with silicone and metallic stents for malignant airway stenosis. Surg Today 2017; 47:1027-1035. [PMID: 28078443 DOI: 10.1007/s00595-016-1466-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022]
Abstract
For severe malignant airway stenosis, there are several types of commercially available airway stents, and each has its own advantages and disadvantages. We herein describe the safety and efficacy of combination stenting with silicone and metallic stents for patients with extended malignant airway stenosis. Seven patients with malignant airway stenosis were treated via combination stenting with a silicone stent and a metallic stent for extended airway stenosis from the central to peripheral airways. Five patients were diagnosed with advanced esophageal cancer, two of whom had tracheoesophageal fistulas. One patient had adenoid cystic carcinoma, and another had mediastinal tumor. There were no specific complications related to the double stenting. Combination stenting with silicone and metallic stents proved to be a safe option for patients with severe, extended, and complicated malignant airway stenosis.
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Affiliation(s)
- Keitaro Matsumoto
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. .,Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Naoya Yamasaki
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.,Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takuro Miyazaki
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Ryotaro Kamohara
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Go Hatachi
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.,Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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15
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Stratakos G, Gerovasili V, Dimitropoulos C, Giozos I, Filippidis FT, Gennimata S, Zarogoulidis P, Zissimopoulos A, Pataka A, Koufos N, Zakynthinos S, Syrigos K, Koulouris N. Survival and Quality of Life Benefit after Endoscopic Management of Malignant Central Airway Obstruction. J Cancer 2016; 7:794-802. [PMID: 27162537 PMCID: PMC4860795 DOI: 10.7150/jca.15097] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/21/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Although interventional management of malignant central airway obstruction (mCAO) is well established, its impact on survival and quality of life (QoL) has not been extensively studied. Aim: We prospectively assessed survival, QoL and dyspnea (using validated EORTC questionnaire) in patients with mCAO 1 day before interventional bronchoscopy, 1 week after and every following month, in comparison to patients who declined this approach. Material/Patients/Methods: 36 patients underwent extensive interventional bronchoscopic management as indicated, whereas 12 declined. All patients received full chemotherapy and radiotherapy as indicated. Patients of the 2 groups were matched for age, comorbidities, type of malignancy and level of obstruction. Follow up time was 8.0±8.7 (range 1-38) months. Results: Mean survival for intervention and control group was 10±9 and 4±3 months respectively (p=0.04). QoL improved significantly in intervention group patients up to the 6th month (p<0.05) not deteriorating for those surviving up to 12 months. Dyspnea decreased in patients of the intervention group 1 month post procedure remaining reduced for survivors over the 12th month. Patients of the control group had worse QoL and dyspnea in all time points. Conclusions: Interventional management of patients with mCAO, may achieve prolonged survival with sustained significant improvement of QoL and dyspnea.
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Affiliation(s)
- Grigoris Stratakos
- 1. 1st Pulmonary Medicine Department of National and Kapodistrian University of Athens, "Sotiria" General Hospital Athens, Greece
| | - Vasiliki Gerovasili
- 2. 1st Respiratory and Critical Care Medicine department of National and Kapodistrian University of Athens, "Evangelismos" Hospital Athens, Greece
| | - Charalampos Dimitropoulos
- 1. 1st Pulmonary Medicine Department of National and Kapodistrian University of Athens, "Sotiria" General Hospital Athens, Greece
| | - Ioannis Giozos
- 3. Oncology Unit, 3rd Department of Internal Medicine of National and Kapodistrian University of Athens, "Sotiria" General Hospital, Athens, Greece
| | - Filippos T Filippidis
- 2. 1st Respiratory and Critical Care Medicine department of National and Kapodistrian University of Athens, "Evangelismos" Hospital Athens, Greece
| | - Sofia Gennimata
- 1. 1st Pulmonary Medicine Department of National and Kapodistrian University of Athens, "Sotiria" General Hospital Athens, Greece
| | - Paul Zarogoulidis
- 4. Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Zissimopoulos
- 5. Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasia Pataka
- 4. Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikos Koufos
- 1. 1st Pulmonary Medicine Department of National and Kapodistrian University of Athens, "Sotiria" General Hospital Athens, Greece
| | - Spyros Zakynthinos
- 2. 1st Respiratory and Critical Care Medicine department of National and Kapodistrian University of Athens, "Evangelismos" Hospital Athens, Greece
| | - Konstantinos Syrigos
- 3. Oncology Unit, 3rd Department of Internal Medicine of National and Kapodistrian University of Athens, "Sotiria" General Hospital, Athens, Greece
| | - Nikos Koulouris
- 1. 1st Pulmonary Medicine Department of National and Kapodistrian University of Athens, "Sotiria" General Hospital Athens, Greece
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16
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Sankuratri S, Samala KB, V P K, Atiketi SB. Embryonic metastatic rhabdomyosarcoma compressing the trachea. J Clin Diagn Res 2015; 9:OL01. [PMID: 25859486 DOI: 10.7860/jcdr/2015/12367.5564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Srinivas Sankuratri
- Senior Consultant, Department of Critical Care, Krishna Institute of Medical Sciences Ltd , Secunderabad, Telangana, India
| | - Kartika BalajI Samala
- Junior Consultant, Department of Critical Care, Krishna Institute of Medical Sciences Ltd , Secunderabad, Telangana, India
| | - Krishna V P
- Junior Consultant, Department of Critical Care, Krishna Institute of Medical Sciences Ltd , Secunderabad, Telangana, India
| | - Srinadh Babu Atiketi
- Junior Consultant, Department of Critical Care, Krishna Institute of Medical Sciences Ltd , Secunderabad, Telangana, India
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17
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Korraa E, Madkour A, Todary A, Wagieh K. Evaluation of bronchoscopic placement of tracheobronchial silicone stents: an Ain Shams University Hospital experience. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2014. [DOI: 10.4103/1687-8426.137350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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18
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Metallic stent placement for the management of tracheal carina strictures and fistulas: technical and clinical outcomes. AJR Am J Roentgenol 2014; 202:880-5. [PMID: 24660720 DOI: 10.2214/ajr.12.10425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this article is to assess the technical and clinical outcomes of metallic stent placement in strictures and fistulas involving the carina. MATERIAL AND METHODS We performed a retrospective analysis of patients who had undergone stenting for disease involving the carina. We initially reviewed the symptoms, underlying causes, and the types of stent configuration used. We also assessed the technical success rate of stenting, its effectiveness in achieving symptomatic relief, the incidence of stent-related complications, and stent patency. RESULTS Thirty-two stenting procedures were performed in 23 patients (mean age, 56.3 years) for the treatment of strictures (n = 21), an esophagorespiratory fistula (n = 1), or both (n = 1) present in the carina. Three cases were associated with benign causes, whereas 20 were related to malignancies. Dyspnea was the most common symptom (n = 22). We placed metallic stents in four different configurations, among which placement in juxtacarinal segments was the most common configuration (n = 23). Technical success was achieved in 96.9% of cases, and symptomatic improvement was observed in 90.6% of cases. Stent-related complications were observed after 10 procedures (31.3%). Stent obstruction occurred in seven patients (21.9% of procedures), most commonly because of tumor progression. The mean follow-up period was 83.1 days, during which time 15 patients died as a result of disease progression, five were discharged without hope for improvement, two were discharged without symptomatic recurrence, and one was lost to follow-up. CONCLUSION Airway stenting can be performed in the carina with high technical success using variable stent configurations. Although the rate of immediate symptomatic improvement is high, stent-related complications frequently occur.
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19
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Hsu AL. Critical airway obstruction by mediastinal masses in the intensive care unit. Anaesth Intensive Care 2013; 41:543-8. [PMID: 23808516 DOI: 10.1177/0310057x1304100417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Critical airway obstruction is a dreaded complication of a mediastinal mass. The acute management is difficult and catastrophic outcomes have been reported. A total of 19 patients, aged between 13 and 69 years, who had critical major airway obstruction due to mediastinal mass requiring mechanical ventilation were reviewed. Three patients had benign pathologies (retrosternal goitre, bronchogenic cyst, giant left atrium) and three had lymphoma. The remaining patients had advanced malignancies: metastatic mediastinal lymphadenopathy (n=6), thyroid carcinoma (n=1) and oesophageal carcinoma (n=6). Three patients underwent surgery, three received chemotherapy and 15 had airway stenting under deep intravenous sedation. Apart from one patient who had brain haemorrhage and nosocomial infection after cardiac surgery, all other patients were successfully weaned off ventilation within five days after the interventions to alleviate the major airway obstruction without major complications. All patients were discharged from hospital without supplemental oxygen. Patients who had benign pathologies and lymphoma (n=6, 32%) were still alive after a mean follow-up period of six years (range 3 to 10) and those with metastatic disease died after a mean survival period of 3.3 months (range 1 to 9). In summary, critical major airway obstruction is caused by a heterogeneous group of mediastinal pathologies, and the definitive treatment and long-term prognosis of these patients are highly dependent on the underlying aetiology. Combining various therapeutic modalities can lead to successful separation of these patients from mechanical ventilation within a short period of time.
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Affiliation(s)
- A L Hsu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
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20
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Gompelmann D, Eberhardt R, Schuhmann M, Heussel CP, Herth FJF. Self-expanding Y stents in the treatment of central airway stenosis: a retrospective analysis. Ther Adv Respir Dis 2013; 7:255-63. [PMID: 23823488 DOI: 10.1177/1753465813489766] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Central airway obstruction (CAO) is a life-threatening situation. Stent insertion re-establishes patency of the central airways. Self-expanding metallic Y stents have been available since 2005, widening the spectrum of interventional bronchoscopic techniques. METHODS Retrospective analysis of all patients treated for CAO with a self-expanding metallic Y stent at the Thoraxklinik Heidelberg between May 2005 and January 2009. RESULTS A total of 43 patients aged 26-81 had a metallic Y stent inserted endoscopically for the treatment of CAO; 39 of these patients (90.7%) had CAO due to malignant disease, four patients (9.3%) due to benign disease. In all 43 patients, the Y stent was deployed without any complications. A longitudinal follow up was possible in 32 of the 43 patients. The stents remained in situ for an average of 107.1 days (range 1-640 days). In 29 patients with malignant CAO the stenosis was successfully overcome with a Y stent; 11 of these patients died within 6 weeks following stent insertion. On follow up the remaining 18 patients showed immediate improvement of dyspnoea. Eight out of the 18 patients (44.4%) tolerated the stent without problems, two (11.1%) required further stenting, six (33.3%) had complications such as increased secretions, cough, dyspnoea or granulation tissue formation. The stent was removed in one patient (5.6%) due to increased secretions, and in another (5.6%) as the stent was no longer required due to successful tumour-specific therapy. CONCLUSION Placement of Y stents in symptomatic CAO allows for quick relief of symptoms. Severe complications are rare. Stent removal is possible after successful treatment of the primary tumour. However, the prognostic indicator for survival is the underlying malignancy.
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Affiliation(s)
- Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg Amalienstr, 5 69126 Heidelberg, Germany
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21
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Murgu S, Langer S, Colt H. Bronchoscopic intervention obviates the need for continued mechanical ventilation in patients with airway obstruction and respiratory failure from inoperable non-small-cell lung cancer. ACTA ACUST UNITED AC 2012; 84:55-61. [PMID: 22759948 DOI: 10.1159/000339316] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/30/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with advanced non-small-cell lung cancer (NSCLC) and acute respiratory failure (ARF) from central airway obstruction (CAO) may be offered end-of-life care rather than intensive care treatment and palliative bronchoscopic intervention. OBJECTIVES To determine whether bronchoscopic intervention could be immediately successful in restoring airway patency and obviate the need for continued mechanical ventilation in a homogeneous group of inoperable mechanically ventilated patients with ARF and CAO from NSCLC. METHODS A retrospective study of 12 consecutive intubated and mechanically ventilated patients with inoperable or unresectable CAO from NSCLC referred for therapeutic bronchoscopic intervention between January 2003 and December 2008. Outcome measures included time-to-postintervention extubation and survival. Procedural success was defined as successful restoration of airway patency, extubation and removal from mechanical ventilation within 24 h after bronchoscopic intervention. RESULTS Twelve intubated and mechanically ventilated patients were admitted to the ICU during the 6-year study period. Airway patency was restored in 11/12 (91%) patients. Bronchoscopic intervention resulted in immediate extubation and discontinuation of mechanical ventilation in 9/12 (75%) patients. Overall median survival was 228 days (range 6-927). For the 9 patients extubated within 24 h after intervention, however, median survival was 313 days (range 6-927). CONCLUSIONS Intubated patients with respiratory failure caused by CAO from NSCLC can be successfully and rapidly removed from mechanical ventilation after bronchoscopic interventions aimed at restoring airway patency. Median survival greater than 10 months justifies ICU hospitalization and referral for bronchoscopic treatment.
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Boyd M, Rubio E. The utility of interventional pulmonary procedures in liberating patients with malignancy-associated central airway obstruction from mechanical ventilation. Lung 2012; 190:471-6. [PMID: 22644069 DOI: 10.1007/s00408-012-9394-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 05/08/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE Utilization of intensive care services by patients with malignancy has risen during the past several decades. Newer cancer therapies have improved overall survival and outcomes. Patients with respiratory failure from central airway obstruction related to tumor growth were previously viewed as inappropriate candidates for ventilator support. However, an increasing number of reports suggest that interventional pulmonary (IP) procedures may benefit such patients. METHODS We reviewed the literature for case reports or case series from the past 20 years regarding the use of IP procedures for the treatment of respiratory failure from malignancy-associated central airway obstruction. RESULTS As a whole, IP procedures were greater than 60 % successful in liberating patients from mechanical ventilation. Moreover, IP procedures served to palliate respiratory symptoms, prolong overall survival, allow for additional cancer treatments, and reduce hospitalization costs. Nevertheless, it remains unclear who may benefit the most from these procedures. CONCLUSIONS Although data are limited, IP procedures are generally safe and should be considered for appropriate patients with respiratory failure from malignancy-associated central airway obstruction as a potential means of liberation from mechanical ventilation.
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Affiliation(s)
- Michael Boyd
- Virginia Tech Carilion School of Medicine, Section of Pulmonary, Critical Care, Environmental, and Sleep Medicine, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA.
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23
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Abstract
Pulmonary symptoms from advanced-stage lung cancer often require palliative treatments for compassionate patient care. Although many of these symptoms can result from complications of advanced lung cancer treatment regimens (ie, radiation/chemotherapy-induced lung toxicity) or the patient's underlying comorbid conditions and poor constitution, a significant number of patients have symptoms that originate from the primary tumor itself or from locoregional metastases within the thoracic cavity. These complications from advanced-stage lung cancer can be a serious threat to life and require appropriate intervention.
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Affiliation(s)
- Aaron M Cheng
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Box 356310, 1959 NE Pacific Street, AA-115, Seattle, WA 98195-6310, USA.
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24
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Puchalski J, Feller-Kopman D. The pulmonologist's diagnostic and therapeutic interventions in lung cancer. Clin Chest Med 2011; 32:763-71. [PMID: 22054884 DOI: 10.1016/j.ccm.2011.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Diagnostic and therapeutic strategies for lung cancer have improved with advancing technology and the acquisition of the necessary skills by bronchoscopists to fully use these advanced techniques. The diagnostic yield for lung cancer has significantly increased with the advent of technologies such as endobronchial ultrasound, navigational systems, and improved imaging modalities. Similarly, the therapeutic benefit of bronchoscopy in advanced lung cancer has begun to be understood for its impact on quality and quantity of life. This article highlights the pulmonologists' diagnostic advances and therapeutic options, with an emphasis on outcomes.
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Affiliation(s)
- Jonathan Puchalski
- Division of Pulmonary and Critical Care Medicine, Yale University School of Medicine, Boardman Building 205, 330 Cedar Street, New Haven, CT 06510, USA.
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25
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Hsu AAL, Phua GC. Threatening Airway Obstruction by Mediastinal Masses: The Experience of a Medical Intensive Care Unit. PROCEEDINGS OF SINGAPORE HEALTHCARE 2011. [DOI: 10.1177/201010581102000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Life-threatening airway obstruction is a dreaded complication of mediastinal masses. The acute management is difficult and catastrophic outcomes have been reported. We describe our experience in a Medical Intensive Care Unit (ICU) and discuss the management options. Design: Retrospective observational study. Setting: 1,600-bed tertiary-care hospital. Patients and Participants: 13 patients were treated between January 1996 and February 2010. Interventions: All patients were mechanically ventilated. Three received emergent chemotherapy, 10 underwent airway stenting and 2 underwent surgery. Measurements and Results: The median age was 51 years (range 13 to 64). In 5 patients (36%), the diagnosis was only made after ICU admission. Two had benign pathologies (retrosternal goitre and bronchogenic cyst) and 3 had lymphoma. The remaining 8 had metastatic mediastinal lymphadenopathy. All were successfully weaned off the ventilator (range 0 to 5 days). All patients with benign pathologies and lymphoma were still alive with a mean follow-up of 2.8 years (range 1 to 7 years). All patients with metastatic disease died, with a mean survival of 3.8 months (range 1 to 9 months). Conclusion: In the management of life-threatening airway obstruction by mediastinal masses, we reported the heterogeneous nature of this group of conditions. Therefore in the intensive care setting, a definitive diagnosis needs to be established urgently, as treatment and prognosis are highly dependent on the underlying etiology. We propose categorising patients into subgroups and combining various therapeutic modalities.
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Affiliation(s)
- Anne Ann Ling Hsu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Ghee Chee Phua
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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26
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Buiret G, Colin C, Landry G, Poupart M, Pignat JC. Determination of predictive factors of tracheobronchial prosthesis removal: stent brands are crucial. Ann Otol Rhinol Laryngol 2011; 120:307-13. [PMID: 21675586 DOI: 10.1177/000348941112000505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to describe in a retrospective study our experience in the endoscopic management of tracheobronchial stenoses over 20 years and to determine prognostic factors of stent removal. METHODS We analyzed the medical records of 166 patients (111 male and 55 female) who underwent the placement of a prosthesis for all causes of tracheobronchial stenosis between 1990 and 2009. RESULTS Overall, 34% of the patients had their stents removed. The incidence of complications for the first stent was 0.08 per patient-month. One hundred five patients (63%) had no complications. In univariate analysis, stent removal was significantly linked with the stent brand. In multivariate analysis, taking into account the causes of stenosis, the stent brand appeared to be the only factor that significantly influenced stent removal. Finally, stenosis with more than 1 stent replacement was most prone to repeat endoscopies. CONCLUSIONS Even though endoscopic stent placement is a relatively safe and effective treatment for tracheobronchial stenoses, particularly in cases with malignancy, complications led to stent removal in about one third of cases. The type of stent chosen is crucial.
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Affiliation(s)
- Guillaume Buiret
- Otorhinolaryngology and Cervicofacial Surgery Unit, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire Lyon , Lyon, France
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27
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Furukawa K, Ishida J, Yamaguchi G, Usuda J, Tsutsui H, Saito M, Konaka C, Kato H. The role of airway stent placement in the management of tracheobronchial stenosis caused by inoperable advanced lung cancer. Surg Today 2010; 40:315-20. [PMID: 20339985 DOI: 10.1007/s00595-008-4058-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 04/28/2008] [Indexed: 12/17/2022]
Abstract
PURPOSE To our knowledge there is no in-depth report on the benefits of airway stenting, which focuses specifically on patients with inoperable advanced lung cancer causing severe central airway obstruction. We evaluated the role of airway stenting as one aspect of the multidisciplinary management of advanced lung cancer. METHODS We performed airway stenting in 40 lung cancer patients, placing a total of 58 stents. Stenting was done as a final modality in 22 patients with terminal-stage lung cancer (group A). The other 18 patients received additional therapy after stenting (group B), 12 (66.7%) of whom were treatment-naïve on admission. RESULTS The performance status (PS) and Hugh-Jones classification (H-J) scores improved in both groups after stenting: from 3.56 to 2.48 (P = 0.001) and 4.29 to 3.20 (P = 0.004) in group A, and from 3.15 to 1.25 (P < 0.001) and 4.10 to 2.10 (P < 0.001) in group B, respectively. The median survival time and 1-year survival rate after stenting were 1.6 months and 5.1%, respectively, in group A, and 5.6 months and 25.0%, respectively, in group B. CONCLUSIONS Airway stenting followed by adjuvant therapy may improve the survival of treatment-naïve patients with severe symptomatic airway obstruction caused by advanced lung cancer.
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Affiliation(s)
- Kinya Furukawa
- Department of Thoracic Surgery, Tokyo Medical University, Kasumigaura Hospital, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan
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Williamson JP, Phillips MJ, Hillman DR, Eastwood PR. Managing obstruction of the central airways. Intern Med J 2009; 40:399-410. [PMID: 19849741 DOI: 10.1111/j.1445-5994.2009.02113.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is the most common cause of cancer death in Australia, Europe and the USA. Up to 20-30% of these cancers eventually affect the central airways and result in reduced quality of life, dyspnoea, haemoptysis, post-obstructive pneumonia and ultimately death. Non-malignant processes may also lead to central airway obstruction and can have similar symptoms. With the development of newer technologies, the last 20 years have seen the emergence of the field of interventional pulmonology to deal specifically with the diagnosis and management of thoracic malignancy, including obstruction of the central airways. This review discusses the pathology, pre-procedure work-up and management options for obstructing central airway lesions. Several treatment modalities exist for dealing with endobronchial pathology with local availability and expertise guiding choice of treatment. While the literature lacks large, multicentre, randomized studies defining the optimal management strategy for a given problem, there is growing evidence from numerous case studies of improved physiology, of quality of life and possibly of survival with modern interventional techniques.
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Affiliation(s)
- J P Williamson
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Western Australia 6009, Australia.
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29
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Lee KE, Shin JH, Song HY, Kim SB, Kim KR, Kim JH. Management of airway involvement of oesophageal cancer using covered retrievable nitinol stents. Clin Radiol 2008; 64:133-41. [PMID: 19103342 DOI: 10.1016/j.crad.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 07/18/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
Abstract
AIM To assess the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement. MATERIALS AND METHODS Under fluoroscopic guidance, covered retrievable nitinol airway stents were placed in 23 oesophageal cancer patients with airway stricture and/or oesophagorespiratory fistula (ERF) over a long period of 12 years. Six patients only had aspiration by ERF and three patients had both airway stricture and asymptomatic ERF. Technical aspects, dyspnoea improvement, and/or resolution of ERF symptoms, complications, reinterventions, and survival data were evaluated. RESULTS A total of 27 airway stents (14 tracheal, 11 bronchial, and two hinged) were placed successfully in 23 patients with airway stricture or ERF. Dyspnoea score decreased significantly after stent placement (p<0.001). ERF were sealed off in all nine patients. Complications included stent migration or expectoration (n=4), haemoptysis (n=2), sputum retention (n=7), and tumour overgrowth (n=1). All three migrated stents were easily removed. Twenty-one patients died, with the median survival period of 76 days (range 2-197 days). CONCLUSION Placement of covered retrievable expandable nitinol stents was safe and effective for the palliative treatment of airway strictures and/or ERF, with a reasonable range of complications, in patients with advanced oesophageal cancer.
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Affiliation(s)
- K E Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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30
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Abstract
The attributable morbidity from central airway obstruction is significant. Airway stenting provides a therapeutic option to manage these complex lesions. This article focuses on the relevant anesthetic considerations of airway stenting in adult patients.
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31
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Management of Tracheobronchial Stenoses With Endoprostheses: Experience With 103 Patients and 11 Models. Laryngoscope 2008; 118:403-7. [DOI: 10.1097/mlg.0b013e31815d8e79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Husain SA, Finch D, Ahmed M, Morgan A, Hetzel MR. Long-term follow-up of ultraflex metallic stents in benign and malignant central airway obstruction. Ann Thorac Surg 2007; 83:1251-6. [PMID: 17383321 DOI: 10.1016/j.athoracsur.2006.11.066] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 11/18/2006] [Accepted: 11/20/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND We report experience with Ultraflex metallic stents (Boston Scientific, Natick, MA) inserted at rigid bronchoscopy under general anesthesia for palliation of benign and malignant upper airway obstruction. METHODS Notes of all patients treated with Ultraflex stents from 1999 to 2003 were reviewed for symptomatic response, spirometric data, and any complications before discharge home. Long-term outcome was assessed by questionnaires sent to patients' general practitioners. RESULTS Recruited were 66 patients (12 benign, 54 malignant airway obstructions). Before discharge home, breathlessness improved in 11 of 12 patients with benign obstruction and in 39 of 54 with malignancies. Postoperative complications in 10 patients with malignant obstructions and in 2 patients with benign obstruction were successfully controlled. It was not possible to perform preoperative pulmonary function tests in most of the patients who presented as emergencies. Mean improvement in forced expiratory volume in 1 second was 0.88 liters in 3 patients with benign obstruction and 0.28 liters in 14 patients with malignant obstruction, and mean peak expiratory flow rate improved by 109 L/min and 97 L/min, respectively. General practitioners completed questionnaires for 12 benign patients and 46 of 54 patients with malignancies. At a mean follow-up of 1017 days (range, 46 to 1120 days), 10 of the 12 patients with benign disease were alive and 7 of 46 patients with malignant airway obstruction were alive, with a median survival of 128 days (mean, 361; range, 3 to 1859 days). Most survivors had Medical Research Council grade III breathlessness or better, with few stent-related symptoms. CONCLUSIONS Ultraflex stents proved safe and effective in prolonged palliation of benign and malignant airways obstruction.
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Affiliation(s)
- Syed A Husain
- Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, United Kingdom.
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Morales JP, Sabharwal T, Man-Harun S, Adam A. Alleviation of severe compressive symptoms in a patient with advanced lung carcinoma using tracheal and superior vena cava stents. J Palliat Med 2007; 10:24-9. [PMID: 17298248 DOI: 10.1089/jpm.2006.0175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lung cancer is now the leading cause of death from cancer worldwide. Although surgery remains the treatment of choice, the majority of patients will be unresectable at presentation with a poor survival outcome. In those patients who also have tracheobronchial involvement; the aim of intervention is to restore airway patency, thus improving quality of life in a minimally invasive way. Superior vena cava (SVC) infiltration by lung carcinoma is present in 3%-5% of patients with lung cancer. In patients with malignant SVC syndrome, the average life expectancy is 3 to 10 months. In these cases the disease progresses rapidly and obstruction develops before there is time for collaterals to develop. We present a case of a 75-year-old man who had alleviation of severe compressive symptoms secondary to advanced lung carcinoma using tracheal and SVC stents placed as a single procedure.
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Affiliation(s)
- Jose Pablo Morales
- Interventional Radiology, Guy's and St Thomas' NHS Foundation Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom.
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Wu CY, Liu YH, Hsieh MJ, Wu YC, Lu MS, Ko PJ, Liu HP. Airway stents in management of tracheal stenosis: have we improved? ANZ J Surg 2007; 77:27-32. [PMID: 17295816 DOI: 10.1111/j.1445-2197.2006.03840.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Airway stenting is an alternative approach for relieving airway stenosis when lesions are inappropriate for single-stage reconstruction. The aim of this study was to present our experience using airway stent in the management of patients with tracheal stenosis. METHODS This study retrospectively reviewed 45 patients who underwent airway stenting during a 2-year period. Between June 2002 and August 2004, 45 patients underwent rigid bronchoscopy for tracheal stenosis using an Ultraflex stent (Microvasive; Boston Scientific, Boston, MA, USA), Hood stent (Hood Laboratories, Pembroke, MA, USA) and Montgomery T-tube (Boston Medical, Westborough, MA, USA). Clinical improvement, intraoperative, early and late postoperative complications were evaluated. RESULTS Ultraflex stent was used in 14 patients, Hood stent in 9 and Montgomery T-tube in 22. The overall clinical improvement was 95.5%. Four per cent of the patients (2/45) had intraoperative complications, 8.8% (4/45) had early postoperative complications and 51% (23/45) had late postoperative complications. No significant difference was determined between stent type and complication rates. CONCLUSION Rigid bronchoscopic insertion of airway stents for tracheal stenosis is a safe and effective procedure. No difference exists between stent type and clinical improvement, intraoperative and early and late postoperative complications.
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Affiliation(s)
- Ching-Yang Wu
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, China
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Outcome of Treated Advanced Non-small Cell Lung Cancer With and Without Central Airway Obstruction. Chest 2006. [DOI: 10.1016/s0012-3692(15)50905-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Matsuda N, Matsumoto S, Nishimura T, Wakamatsu H, Kunihiro M, Sakabe T. Perioperative management for placement of tracheobronchial stents. J Anesth 2006; 20:113-7. [PMID: 16633769 DOI: 10.1007/s00540-005-0379-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 12/23/2005] [Indexed: 11/25/2022]
Abstract
Tracheobronchial stenting was performed under general anesthesia, with (six patients) or without (two patients) muscle relaxant, in eight patients suffering from carcinoma. All patients had presented preoperatively with dyspnea, exhibiting Hugh-Jones grade 4 or 5. Three patients had been mechanically ventilated before the procedure. The procedure was performed under general anesthesia with flexible bronchoscopic guidance. Stent placement was performed either through an orotracheal tube (four patients) or through a transtracheal tube (two patients) in those who had no upper tracheal stenosis, while it was performed through a laryngeal mask airway in two patients with upper tracheal stenosis. During the procedure, arterial hemoglobin oxygen saturation (Sp(O(2)) decreased in all patients, despite fraction of inspired oxygen (FI(O(2)) being maintained at 1.0. Except for two patients, one of whom developed superior vena cava syndrome and one, tension pneumothorax after stent placement, there were no complications resulting from stent placement. Six patients were weaned from mechanical ventilation (0-24 days after the procedure). Two of the three patients who had been on mechanical ventilation preoperatively could not be weaned. Stent insertion is an effective treatment for tracheobronchial stenosis, but its indications in patients with malignancy who have been mechanically ventilated prior to stenting should further be evaluated.
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Affiliation(s)
- Norimasa Matsuda
- Department of Critical Care Medicine, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan
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Profili S, Manca A, Feo CF, Padua G, Ortu R, Canalis GC, Meloni GB. Palliative Airway Stenting Performed Under Radiological Guidance and Local Anesthesia. Cardiovasc Intervent Radiol 2006; 30:74-8. [PMID: 17031728 DOI: 10.1007/s00270-006-0027-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the effectiveness of airway stenting performed exclusively under radiological guidance for the palliation of malignant tracheobronchial strictures. METHODS We report our experience in 16 patients with malignant tracheobronchial stricture treated by insertion of 20 Ultraflex self-expandable metal stents performed under fluoroscopic guidance only. Three patients presented dysphagia grade IV due to esophageal malignant infiltration; they therefore underwent combined airway and esophageal stenting. All the procedures were performed under conscious sedation in the radiological room; average procedure time was around 10 min, but the airway impediment never lasted more than 40 sec. RESULTS We obtained an overall technical success in 16 cases (100%) and clinical success in 14 patients (88%). All prostheses were successfully placed without procedural complications. Rapid clinical improvement with symptom relief and normalization of respiratory function was obtained in 14 cases. Two patients died within 48 hr from causes unrelated to stent placement. Two cases (13%) of migration were observed; they were successfully treated with another stent. Tumor overgrowth developed in other 2 patients (13%); however, no further treatment was possible because of extensive laryngeal infiltration. CONCLUSIONS Tracheobronchial recanalization with self-expandable metal stents is a safe and effective palliative treatment for malignant strictures. Airway stenting performed exclusively under fluoroscopic view was rapid and well tolerated.
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Affiliation(s)
- Stefano Profili
- Department of Radiology, University of Sassari, Sassari, Italy
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Rigid Bronchoscopic Intervention in Patients with Respiratory Failure Caused by Malignant Central Airway Obstruction. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200605000-00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rigid Bronchoscopic Intervention in Patients with Respiratory Failure Caused by Malignant Central Airway Obstruction. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31588-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Cosano Povedano A, Muñoz Cabrera L, Cosano Povedano FJ, Rubio Sánchez J, Pascual Martínez N, Escribano Dueñas A. [Endoscopic treatment of central airway stenosis: five years' experience]. Arch Bronconeumol 2005; 41:322-7. [PMID: 15989889 DOI: 10.1016/s1579-2129(06)60231-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe our experience with interventional bronchoscopy in the treatment of central airway stenosis. PATIENTS AND METHODS We reviewed patient records and bronchoscopic findings. Clinical data, findings from computed tomography, techniques performed, complications, and results were recorded. RESULTS One-hundred and thirty-six patients (90 males and 46 females) were treated. The mean (SD) age was 57 (7) years (range, 3-81). A total of 320 therapeutic interventions were performed: 145 laser treatments, 33 balloon or mechanical dilatations, 26 electrocauterizations, and 116 stent insertions. Pathogenesis varied: in 64 (47%) patients, the stenosis was caused by a tumor (48 were bronchopulmonary and 16 nonpulmonary); in 72 (53%) patients, stenosis was secondary to a nontumor-related process, of which the most common was prolonged intubation (42% of these cases). Central airway patency was achieved in 92% (59/64) of the tumor-related stenoses and 96% (69/72) of those unrelated to tumors. Improvement in dyspnea was observed in 96% of all patients. Two deaths (due to hemoptysis and to acute myocardial infarction) occurred in the first week, for a 1.4% mortality rate. The most common complications were stent migration (8%; 9/116 cases) and the formation of granulomas (9%; 11/116). CONCLUSIONS Interventional bronchoscopy is an effective technique to resolve life-threatening obstructions of the central airways. Dyspnea improves immediately and there is no significant morbidity or mortality.
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Affiliation(s)
- A Cosano Povedano
- Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain.
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Cosano Povedano A, Muñoz Cabrera L, Cosano Povedano F, Rubio Sánchez J, Pascual Martínez N, Escribano Dueñas A. Cinco años de experiencia en el tratamiento endoscópico de las estenosis de la vía aérea principal. Arch Bronconeumol 2005. [DOI: 10.1157/13076000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Raza SA, Walser E, Hernandez A, Ozkan O. Percutaneous Transtracheal Approach for Endobronchial Stenting. AJR Am J Roentgenol 2005; 184:225-6. [PMID: 15615979 DOI: 10.2214/ajr.184.1.01840225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Syed A Raza
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0709, USA.
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Madden BP, Park JES, Sheth A. Medium-Term Follow-Up After Deployment of Ultraflex Expandable Metallic Stents to Manage Endobronchial Pathology. Ann Thorac Surg 2004; 78:1898-902. [PMID: 15560997 DOI: 10.1016/j.athoracsur.2004.05.062] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Between March 1997 and March 2004 we deployed 80 Ultraflex metallic expandable stents (Boston Scientific, Waterson, MA) in 69 patients under direct vision using rigid bronchoscopy. We report our medium- to long-term experience in patients for whom these stents were deployed. METHODS To date 15 patients have been followed for more than 1 year (median 41 months, range 12 to 83 months) after stent deployment. Indications for stenting in these patients were neoplasia (5), stricture (5), airway malacia (1), iatrogenic tracheal tear (1), and compression from an aortic aneurysm (1), a right interrupted aortic arch (1), and a right brachiocephalic artery aneurysm with tracheomalacia (1). Ten tracheal stents (9 covered, 1 uncovered) and 10 bronchial stents (8 uncovered, 2 covered) were inserted, and 5 patients received two stents. RESULTS Five of these patients experienced no long-term problems. Complications included troublesome halitosis (5), which was difficult to treat despite various antibiotic regimes; granulation tissue formation above and below the stent that was successfully treated with low-power Nd:YAG laser therapy (7); and metal fatigue (1). We did not encounter stent migration. CONCLUSIONS We conclude that Ultraflex expandable metallic stents have an important role in the management of selected patients with diverse endobronchial pathologies and are well tolerated in the long-term. Although associated granulation tissue can be successfully treated with Nd:YAG laser, halitosis can be a difficult problem to address.
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Affiliation(s)
- Brendan P Madden
- Department of Cardiothoracic Surgery, St. George's Hospital, London, England, UK.
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Dutau H, Toutblanc B, Lamb C, Seijo L. Use of the Dumon Y-stent in the management of malignant disease involving the carina: a retrospective review of 86 patients. Chest 2004; 126:951-8. [PMID: 15364778 DOI: 10.1378/chest.126.3.951] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Hervé Dutau
- Thoracic Endoscopy Center, Hôpital Sainte Marguerite, 270 Blvd de Sainte Marguerite, 13009 Marseille, France.
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Allison R, Sibata C, Sarma K, Childs CJH, Downie GH. High-Dose-Rate Brachytherapy in Combination with Stenting Offers a Rapid and Statistically Significant Improvement in Quality of Life for Patients with Endobronchial Recurrence. Cancer J 2004; 10:368-73. [PMID: 15701268 DOI: 10.1097/00130404-200411000-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Symptomatic endobronchial recurrence after treatment failure is common in advanced non-small cell lung cancer. Optimal palliation has yet to be defined. We examined the combination of near-simultaneous, high-dose-rate (HDR) brachytherapy with stenting in this cohort of patients. Informed consent for intervention was obtained for 10 patients experiencing severely symptomatic (hemoptysis and oxygen-dependent shortness of breath), biopsy-proven endobronchial recurrence. All patients (eight men, two women, aged 52-77 years) had failed to respond to chemoradiotherapy for stage IIIB non-small cell lung cancer. Intervention consisted of placement of a self-expanding metallic stent (Nitinol/Ultraflex stent, Boston Scientific Co., Natick, MA) into the obstructing region. During that same bronchoscopy, HDR catheters were introduced. A dose of 6 Gy at 0.5 cm from the catheter was then delivered via an HDR unit. Two additional HDR sessions followed at weekly intervals for a total dose of 18 Gy. Patients under went follow-up bronchoscopes 1 month after the last HDR and when clinically indicated. All patients completed the prescribed therapy. No morbidity was noted from bronchoscopy, HDR, or stenting. All patients had rapid relief of signs and symptoms. At 1 week after stenting/first HDR, a statistically significant improvement in Karnofsky status was noted. Pulmonary palliation was maintained for the duration of their survival. The radio-opaque stent also offered significant advantages for catheter placement and verification during the HDR procedure. Although this series is small, the beneficial outcome obtained deserves further evaluation.
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Affiliation(s)
- Ron Allison
- Department of Radiation Oncology, The Brody School of Medicine, Greenville, North Carolina 27858, USA.
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Abstract
Because of the close anatomical relationship between the upper esophagus and the tracheobronchial tree, many patients with advanced esophageal cancer will suffer from airway complications. These include airway stenosis or esophago-respiratory fistulation. Airway stenting is proven to offer effective palliation for patients with both these complications. When managing such patients, the thoracic surgeon faces different options in terms of pre-stenting investigation, choice of stents and stenting strategy. Although airway stenting is a safe and effective procedure in experienced hands, there are nonetheless complications which await the unwary. This review discusses the currently available options for airway stenting in these patients, and offers practical advice on avoiding the pitfalls.
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Affiliation(s)
- Alan D L Sihoe
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Abstract
Central airway obstruction is a problem facing all medical and surgical subspecialists caring for patients with chest diseases. The incidence of this disorder appears to be rising because of the epidemic of lung cancer; however, benign causes of central airway obstruction are being seen more frequently as well. The morbidity is significant and if left untreated, death from suffocation is a frequent outcome. Management of these patients is difficult, but therapeutic and diagnostic tools are now available that are beneficial to most patients and almost all airway obstruction can be relieved expeditiously. This review examines current approaches in the workup and treatment of patients suffering from airway impairment. Although large, randomized, comparative studies are not available, data show significant improvement in patient outcomes and quality of life with treatment of central airway obstruction. Clearly, more studies assessing the relative utility of specific airway interventions and their impact on morbidity and mortality are needed. Currently, the most comprehensive approach can be offered at centers with expertise in the management of complex airway disorders and availability of all endoscopic and surgical options.
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Affiliation(s)
- Armin Ernst
- Pulmonology and Critical Care Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Affiliation(s)
- Jay B Brodsky
- Department of Anesthesia, Stanford University Medical Center School of Medicine, CA 94305, USA.
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Miyazawa T, Miyazu Y, Iwamoto Y, Ishida A, Kanoh K, Sumiyoshi H, Doi M, Kurimoto N. Stenting at the Flow-limiting Segment in Tracheobronchial Stenosis due to Lung Cancer. Am J Respir Crit Care Med 2004; 169:1096-102. [PMID: 15132959 DOI: 10.1164/rccm.200312-1784oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Airway stenting at the wave-speed flow-limiting segment (the choke point) is assessed. We determined prospectively the precise location of the choke point using the flow-volume curve, endobronchial ultrasonography, ultrathin bronchoscopy, and three-dimensional computed tomography scan before and after stenting in 64 patients with extrincic compression due to lung cancer. We noted distinct flow-volume curve patterns specific to the type of stenosis. The tracheal stenosis group indicated fixed narrowing patterns with an expiratory plateau, bronchial stenosis group dynamic collapse patterns with an expiratory flow deterioration (choking), carinal stenosis group combined fixed and dynamic patterns, and extensive stenosis group complex patterns containing elements of all the former. After stenting, almost full-function patterns with significant improvement in PEF were observed in all groups (p < 0.01, p < 0.05, p < 0.001, p < 0.01, respectively). In patients with extensive stenosis, implantation of additional stents was required when the choke points were observed to have migrated to the areas of malacia with cartilage destruction by the tumor. Secondary stenting at migrated choke points resulted in a significant improvement in PEF over the initial stenting (p < 0.01). Stenting at the choke point improved expiratory flow limitation by increasing the cross-sectional area, supporting the weakened airway wall and relieving dyspnea.
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Affiliation(s)
- Teruomi Miyazawa
- Department of Pulmonary Medicine, Hiroshima City Hospital, 7-33 Naka-Ku, Moto-machi, Hiroshima, Japan 730-8518.
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