Self-expandable metallic tracheobronchial stent insertion and endobronchial electrocautery with flexible bronchoscopy: preliminary results at a cancer center.
OBJECTIVE
Technical developments have facilitated the implantation of metallic stents and the use of endobronchial electrocautery through a flexible bronchoscope to reestablish airway patency in patients with airway obstruction. Their application in a 180-bed cancer center is described.


METHODS
From August 2000 to December 2001, 12 patients (2 women, 10 men, mean age 53.3 yr) were treated by insertion of a self-expandable metallic tracheobronchial stent (SEMS). Malignant airway obstruction was the indication for the procedure in nine patients, two of whom underwent preliminary debulking using SEMS with or without electrocautery. Severe benign subglottic or tracheal stenosis was the indication for the procedure in two patients. The remaining patient with esophageal cancer received a double bronchial and esophageal SEMS due to involvement of a non-obstructing bronchoesophageal fistula.


RESULTS
Symptomatic improvement was seen in all 12 patients. Removal was performed in one patient. Five patients died during follow-up with a median survival of 44 days, attributed to the advanced stage of recurrent disease. The median follow-up for the six surviving patients was 23 weeks. No major short-term complications of the procedure were found.


CONCLUSIONS
SEMS is a promising technique for the management of airway obstruction. The stent is selected according to the specific clinical situation. Metallic and silicone stents are complementary. SEMS should not be used in patients who require only temporary relief of tracheobronchial obstruction.
Division of Pulmonary and Critical Care Medicine, Koo Foundation Sun Yat-Sen Cancer Center Hospital, 125 Lih-Der Road, Pei-Tou District, Taipei, Taiwan.
Li-Han
LH
Hsu
Chia-Chuan
CC
Liu
Ching-Yuan
CY
Lin
K Lawrence
KL
Yen
Kwan-Yee
KY
Chan
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D001980:Bronchi; D001983:Bronchial Fistula / Q000209:etiology / Q000628:therapy; D001999:Bronchoscopy; D004564:Electrocoagulation; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000628:therapy; D015607:Stents; D014132:Trachea; D014133:Tracheal Diseases / Q000209:etiology / Q000628:therapy