title: Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement.
abstract: BACKGROUND
  Most inoperable patients with esophageal-advanced cancer (EGC) have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC.
  
  
  RESULTS
  The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\-8 years of age) with esophageal stenting indication were investigated. Seven patients (group 1) were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression). Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2): stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication). Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks) than in group 2 (28+/-11 weeks), p<0.001). Scheduled double stenting significantly improved symptoms (95% at day 7) with a low complication rate (13%), and achieved a specific cancer treatment (84%) in most cases.
  
  
  CONCLUSIONS
  Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased airways complications related to esophageal stent. Emergency procedures were rarely efficient in our experience.
authors.affiliation: Service de Pneumologie, GHSR, St Pierre, France. f.paganin@orange.fr
authors.forename: Fabrice
authors.initials: F
authors.lastname: Paganin
authors.forename: Laurent
authors.initials: L
authors.lastname: Schouler
authors.forename: Laurent
authors.initials: L
authors.lastname: Cuissard
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Noel
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Becquart
authors.forename: Mathieu
authors.initials: M
authors.lastname: Besnard
authors.forename: Laurent
authors.initials: L
authors.lastname: Verdier
authors.forename: Denis
authors.initials: D
authors.lastname: Rousseau
authors.forename: Claude
authors.initials: C
authors.lastname: Arvin-Berod
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourdin