Airway stenting for the treatment of laryngotracheal stenosis secondary to thyroid cancer.
OBJECTIVE
Airway stenting can be a valuable therapeutic option for symptomatic airway stenosis, but its role in the palliation of advanced thyroid cancers invading the upper airway is unclear. This study examined the hypothesis that durable and replaceable silicone stents would give better results than self-expanding metallic stents.


METHODS
A retrospective analysis was conducted of consecutive patients stented for laryngotracheal obstruction due to thyroid cancer. Stenting was performed via a rigid bronchoscope when airway patency after dilatation was <or=50% of normal. Symptomatic improvement, Hugh-Jones (H-J) classification, Eastern Cooperative Oncology Group performance status (PS), and complications were analysed.


RESULTS
There were 37 stenotic lesions treated in 35 patients. The most common sites for these lesions were in the inclusive area extending from the cricoid cartilage to the first tracheal ring (26/37 lesions, 70%). Forty-five stents (12 silicone, 20 metallic, 13 T-tubes) were used in 43 interventions. All patients showed immediate symptomatic relief and significant improvement in both PS and H-J classifications. Critical complications were supraglottic stenosis (5/43 interventions, 12%) and, of those same five cases, stent migration was seen in all but one (4/45 implantations, 9%). As these complications occurred only in patients in whom the silicone stents had been placed in close proximity to the cricoid cartilage (5/10 patients, 50%), this emphasizes the unsuitability of silicone stents in such cases. The median survival time from stenting was 8 months. The 1-year survival rate was 40%.


CONCLUSIONS
Airway stenting can achieve significant palliation in patients with thyroid cancer and airway obstruction. The study showed that for the most common lesions, the uncovered Ultraflex stent is associated with fewer critical complications than the silicone stents.
Department of Chest and Thyroid Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
Hidemitsu
H
Tsutsui
Mitsuhiro
M
Kubota
Masae
M
Yamada
Akihiko
A
Suzuki
Jitsuo
J
Usuda
Hiroshi
H
Shibuya
Kuniharu
K
Miyajima
Kiminori
K
Sugino
Koichi
K
Ito
Kinya
K
Furukawa
Harubumi
H
Kato
D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002277:Carcinoma / Q000150:complications; D002291:Carcinoma, Papillary / Q000150:complications*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007829:Laryngostenosis / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012828:Silicones; D015607:Stents; D013964:Thyroid Neoplasms / Q000150:complications*; D014135:Tracheal Stenosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome
D012828:Silicones