title: Placement of self-expandable metallic stents for tracheal stenosis secondary to thyroid cancer.
abstract: The indications and suitable approaches for treating upper airway obstruction secondary to thyroid cancer are controversial. Patients with thyroid cancer generally have a good prognosis, but airway stenosis and vocal cord paralysis are not uncommon. Subglottic airway stenting may be challenging, due to stent migration, granulation tissue formation and supraglottic stenosis. In this study, we evaluated the application of covered self-expandable metallic stents to relieve upper airway obstruction. This was a retrospective study of 5 patients with airway stenosis due to thyroid cancer treated in 2009 and 2010. Immediate airway enlargement was achieved in 3 patients with stenosis at the middle mediastinum. Gradual enlargement over 2 months was observed in the remaining 2 patients with stenosis at the cervical level. The performance status was improved in all 5 patients, including a case with anaplastic carcinoma. The follow-up averaged 13 months (range, 8-27 months). Granulation tissue developed at both ends of the stent in 3 patients, sputum was retained in 2 cases and bacterial colonization was detected in all 5 cases. No stent migration was reported. Additional tracheostomy was required in 2 patients, due to proximal tumor growth or progressive bilateral vocal cord paralysis after 10 and 6 months, respectively. In conclusion, stenting for central airway stenosis secondary to thyroid cancer may be beneficial, even in patients with anaplastic carcinoma. Long-term regular bronchoscopic follow-up is required to monitor complications, as patients with thyroid cancer are at high risk of granulation tissue formation, sputum retention and bacterial colonization.
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Rena
authors.initials: R
authors.lastname: Yuasa
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Hata
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Otsuka
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Makino
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koezuka
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Fumitomo
authors.initials: F
authors.lastname: Sato
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tamaki
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Sasamoto
authors.affiliation: Nishi Yokohama International Hospital, Yokohama, Kanagawa 245-0062, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Iyoda
keywords: airway obstruction; flexible bronchoscopy; self-expandable metallic stents; thyroid cancer; tracheal stenosis