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J Thorac Cardiovasc Surg 1996;112:859-866
© 1996 Mosby, Inc.

GENERAL THORACIC SURGERY

EMERGENCY STENTING OF MALIGNANT OBSTRUCTION OF THE UPPER AIRWAYS: LONG-TERM FOLLOW-UP WITH TWO TYPES OF SILICONE PROSTHESES*

Received for publication Feb. 5, 1996 Revisions requested March 12, 1996; revisions received April 9, 1996 Accepted for publication April 11, 1996. Address for reprints: Klaus Wassermann, MD, Third Department of Internal Medicine, University of Cologne, Building D/O, Room 409, Josef-Stelzmann-Straße 9, 50924 Köln, Germany.

Abstract

Objective: We evaluated the long-term prognosis of stents placed on an emergency basis in the trachea and its bifurcation for malignant stenosis.

Methods: We retrospectively analyzed all bronchologic treatments of obstructing airway lesions from January 1993 to December 1995.

Results: We report on 10 patients with severe malignant "mixed-type" obstruction of the proximal trachea or distal trachea plus both main-stem bronchi. They had far-advanced inoperable tumor (esophageal cancer: n= 4; lung cancer: n= 3; recurrent laryngeal, uvula, and thyroid cancer: n= 1 each). Emergency treatment consisted of a dilating bougie maneuver followed by the insertion of a large one-way (n= 4) or Y-shaped silicone prosthesis (n= 6). After the intervention, there was a long-lasting clinical improvement. Median survival from stent insertion was 8 months for all patients irrespective of tumor type; it was 5 months for patients with lung carcinoma and 8 months for those with esophageal cancer. The results are in accordance with other studies using different therapeutic modalities. Stent exchange was necessary in five patients. Main reasons were continuing tumor growth beyond the proximal and distal boundaries and recurrent productive bronchial infection. Patients died of pneumonia (n= 4), pulmonary lymphatic spread (n= 1), cardiac failure (n= 2), and fatal hemorrhage (n= 1). As of December 1995, three patients were still alive 2, 5, and 8 months after implantation.

Conclusions: As evidenced by clinical efficiency and length of palliation, endoscopic placement of silicone-based one-way and bifurcational prostheses in far-advanced tumor of the central airways is technically feasible and ethically justifiable. (J THORACCARDIOVASCSURG1996;112:859-66)

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