title: Decannulation in tracheal stenosis deemed inoperable is possible after long-term airway stenting.
abstract: BACKGROUND
  Decannulation is the ultimate therapeutic goal for patients who undergo stenting because of inoperable benign tracheal stenosis. In this study, our objectives were to evaluate whether long-term airway stenting allows decannulation in patients with benign tracheal stenosis who were deemed inoperable and to identify possible predictive factors for successful decannulation (SD).
  
  
  METHODS
  Retrospective cohort study including all patients with inoperable benign tracheal stenosis who underwent tracheal stenting in our tertiary-care university-based institution from 1998 to 2008. For benign stenosis, we use only silicone stents (T tubes, Dumon stents, and Y stents). The main outcome was SD, which was defined as removal of the tracheal stent followed by absence of respiratory symptoms and no requirement for new dilation procedures for at least 6 months. A Kaplan-Meier curve was built to evaluate SD in 5 years, and we used a Cox model to evaluate predictors for a SD.
  
  
  RESULTS
  Ninety-two patients were included, and during the study period 21 were decannulated. However, 2 of them had to undergo new airway procedures and were considered to represent failure. Therefore, 19 patients were successfully decannulated. According to the Kaplan-Meier estimate, the SD rate in 5 years was 27.5%. The mean follow-up time after SD was 34.3 ± 33.9 months (range, 6 to 108 months). Cox regression showed only 1 significant factor: tracheostomy before stent insertion caused a threefold increase in the likelihood of the patient remaining with a tracheal stent (p = 0.048).
  
  
  CONCLUSIONS
  Tracheal stenting may be considered a curative therapeutic approach in as many as 27.5% of patients with inoperable benign tracheal stenosis.
authors.affiliation: Thoracic Surgery Department, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Ricardo Mingarini
authors.initials: RM
authors.lastname: Terra
authors.forename: Benoit Jacques
authors.initials: BJ
authors.lastname: Bibas
authors.forename: Helio
authors.initials: H
authors.lastname: Minamoto
authors.forename: Daniel Reis
authors.initials: DR
authors.lastname: Waisberg
authors.forename: Mauro Federico Luis
authors.initials: MF
authors.lastname: Tamagno
authors.forename: Miguel Lia
authors.initials: ML
authors.lastname: Tedde
authors.forename: Paulo Manuel
authors.initials: PM
authors.lastname: Pêgo-Fernandes
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000328:Adult; D002404:Catheterization; D015331:Cohort Studies; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014135:Tracheal Stenosis / Q000601:surgery*