title: Bronchoscopic management of patients with symptomatic airway stenosis and prognostic factors for survival.
abstract: BACKGROUND
  Interventional bronchoscopy is effective in the management of patients with symptomatic airway obstruction for both malignant and benign conditions. The main aim of this study is to report our experience with emergency interventional bronchoscopy in patients with symptomatic airway obstruction and identify prognostic factors for survival.
  
  
  METHODS
  This is a retrospective observational study of patients undergoing emergency interventional bronchoscopy over a 4-year period. Survival times were analyzed separately for patients with benign and malignant airway obstruction by the Kaplan-Meier method.
  
  
  RESULTS
  Between June 2009 and July 2013, 168 emergency interventional bronchoscopies were performed in 112 patients for airway obstruction. The median age was 63 years (range, 20 to 86), and 91 patients (54%) patients were female. Seventy-two cases (43%) had airway obstruction due to malignant disease. There were 3 in-hospital deaths (2.7%). Median survival of the study population was 5.6 months (range, 0 to 51) with a median follow-up of 7.3 months (range, 0 to 51). Median survival for patients with malignant airway obstruction was 3.5 months (range, 0 to 21), and 9.8 months (range, 0.1 to 51) for those with benign disease. Airway intervention facilitated palliative chemotherapy in 32 patients (44%) of those with malignant airway obstruction. At multivariate analysis in patients with malignant airway obstruction, presence of stridor (hazard ratio 1.919, 95% confidence interval: 1.082 to 3.404, p = 0.026) and not receiving postprocedure chemotherapy (hazard ratio 2.05, 95% confidence interval: 1.156 to 3.636, p = 0.014) were independent prognostic factors for death.
  
  
  CONCLUSIONS
  Emergency interventional bronchoscopy for airway obstruction is safe, relieved symptoms, and facilitated palliative chemotherapy, which improved survival.
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Okiror
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Oswald
authors.affiliation: Department of Thoracic Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bille
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Pala
authors.initials: P
authors.lastname: Rajesh
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Ehab
authors.initials: E
authors.lastname: Bishay
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Steyn
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Babu
authors.initials: B
authors.lastname: Naidu
authors.affiliation: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom. Electronic address: maninder.kalkat@heartofengland.nhs.uk.
authors.forename: Maninder
authors.initials: M
authors.lastname: Kalkat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001982:Bronchial Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001999:Bronchoscopy; D003251:Constriction, Pathologic / Q000209:etiology / Q000401:mortality; D004630:Emergencies; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012142:Respiratory Tract Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D014135:Tracheal Stenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult