Indications and clinical outcomes of fully covered self-expandable metallic tracheobronchial stents in patients with malignant airway diseases

ABSTRACT

Background

Airway stenting is an efficacious approach in management of malignant airway disease (MAD) with improvement in survival outcome.

Objective

To determine the indications and long-term clinical outcomes of tracheobronchial stenting in patients with MAD.

Methods

A cross-sectional review of 51 patients who underwent airway stenting from June 2011 to June 2019 was done. Paired t-test was used to compare mean difference of clinical characteristics between pre- and post-airway stenting. Kaplan–Meier curves were used to assess overall survival.

Results

A total of 51 patients had stent insertion with mean age 46.63±17.10years including 27(52.9%) females. Mainly 37(72.5%) patients had esophageal and 06(11.8%) had lung cancer. The main indications were bronchial stenosis 18(35.3%), tracheal stenosis 11(21.6%) and Tracheo-esophageal/bronchial fistula 13(25.5%). Obstruction was intrinsic, extrinsic and mixed in 20(39.2%), 13(25.5%) and 5(9.8%) patients, respectively. There was statistically significant mean difference in pre- and post-procedure oxygen saturation (mean (M)=89.8, standard deviation (SD)=6.70 vs M =95.5,SD=2.54.p =0.001) and performance status (M =3.65,SD =0.6 vs M =2.59, SD=0.83.p =0.001). Overall median survival was 16±3.44 weeks, highest amongst patients with intrinsic obstruction (27±6.51 weeks).

Conclusion

Airway stenting is an effective endoscopic procedure to re-establish airway patency in MAD with minimal complications..

KEYWORDS:

• Airway obstruction
• trachea-esophageal/bronchial fistula
• fully covered self-expandable metallic stents

Article highlights

• Airway stenting by using fully covered self-expandable metallic tracheobronchial stents is an efficacious mean of palliating the symptoms of the patients with malignant airway disease

• The main cause of malignant airway disease in our study cohorts was esophageal cancer 37 (72.5%), out of those 35 (94.6%) had squamous cell carcinoma and 2(5.4%) had adenocarcinoma, followed by lung cancer 6 (11.8%).

• Major indications were bronchial stenosis 18 (35.3%), tracheal stenosis 11 (21.6%) and tracheo esophageal/bronchial fistula 13 (25.5%).

• 20 (39.2%) patients had intrinsic obstruction, 13 (25.5%) had extrinsic obstruction 5 (9.8%) had a mixed obstruction and no obstruction was found in 13(25.5%) patients.

• Majority 49 (96.0%) of patients showed immediate improvement in symptoms post- airway stenting, out of which 45% were in good performance status

• The overall post procedure median survival time was 16 ± 3.44 weeks, highest in patients with intraluminal obstruction and in those who received preand post- procedure chemotherapy and radiotherapy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Ethical approval

Obtained from the Institutional Review Board (IRB No. EX-05-11-19-05).

Informed consent

Not required as the retrospective nature of the study

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.