The integrated place of tracheobronchial stents in the multidisciplinary management of large post-pneumonectomy fistulas: our experience using a novel customised conical self-expandable metallic stent.
BACKGROUND
Stump dehiscence after pneumonectomy is a cause of morbidity and mortality in patients treated for non-small-cell lung carcinoma. Surgical repair remains the treatment of choice but can be postponed or contraindicated. Bronchoscopic techniques may be an option with curative intent or as a bridge towards definitive surgery. The aim of the study is to evaluate the efficacy and the outcome of a new customised covered conical self-expandable metallic stent in the management of large bronchopleural fistulas complicating pneumonectomies.


METHODS
A case series using chart review of non-operable patients presenting with large bronchopleural fistulas (>6mm) post-pneumonectomies as a definitive treatment with curative intent for non-small-cell lung carcinomas and requiring the use of a dedicated conical shaped stent in two tertiary referral centres.


RESULTS
Seven patients presenting large post-pneumonectomy fistulas (between 6 and 12 mm) were included. Cessation of the air leak and clinical improvement was achieved in all the patients after stent placement. Stent-related complications (two migrations and one stent rupture) were successfully managed using bronchoscopic techniques in two patients and surgery in one. Mortality, mainly related to overwhelming sepsis, was 57%. Delayed definitive surgery was achieved successfully in three patients (43%).


CONCLUSIONS
This case series assesses the short-term clinical efficacy of a new customised covered conical self-expandable metallic stent in the multidisciplinary management of large bronchopleural fistulas complicating pneumonectomies in patients deemed non-operable. Long-term benefits are jeopardised by infectious complications.
Dutau
Hervé
H
Thoracic Endoscopy Unit, Sainte Marguerite University Hospital, Marseille, France. herve.dutau@mail.ap-hm.fr
Breen
David Patrick
DP
Gomez
Carine
C
Thomas
Pascal Alexandre
PA
Vergnon
Jean-Michel
JM
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology; D011013:Pneumonectomy / Q000009:adverse effects*; D011474:Prosthesis Design; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000628:therapy*; D015607:Stents; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome