title: Palliation of Concomitant Tracheobronchial and Esophageal Disease Using a Combined Airway and Esophageal Approach.
abstract: BACKGROUND
  Neoplastic involvement of the mediastinum can contribute to both airway and esophageal pathology. That can manifest as combined esophageal and airway stenosis, or tracheobronchoesophageal fistula. Conventional palliative treatment of these problems consists of endoluminal stent insertion. The double stenting approach consists of insertion of a tracheobronchial and an esophageal stent in parallel and allows concomitant symptomatic relief of both the airway and esophageal pathology.
  
  
  METHODS
  The study consists of a retrospective case series of patients who underwent a double stenting procedure for concomitant airway and esophageal disease between August 2009 and September 2014. The type of airway stent chosen was determined based on the pathology and the level of the lesion (simple tubular in the mid trachea or mainstem bronchus, Y-stent for carina).
  
  
  RESULTS
  Thirty-nine patients were treated using the double stenting approach during a combined procedure over 5 years: 15 patients with tracheobronchoesophageal fistula and 24 with stenosis. Immediate relief of symptoms, defined as resuming oral intake and breathing without an external tracheal device, was observed in 25 patients (64%). Thirty-two patients (82%) were discharged from hospital, and 7 patients died in hospital (18%). Of these 7 deaths, 6 patients died of pulmonary complications. Inhospital complications occurred in 11 patients (28%). Of the patients discharged from the hospital, 14 died during a mean follow-up period of 54 days. Mean and median survival were 49 and 24 days, respectively (range, 1 to 448), and median hospital stay was 3 days (range, 1 to 46).
  
  
  CONCLUSIONS
  Treatment of combined airway and esophageal pathology using a double stenting approach is safe, feasible, provides reasonable immediate palliation of symptoms, and is associated with acceptable morbidity. It is a palliative procedure that allows for early hospital discharge of patients who are diagnosed with an incurable malignancy.
authors.affiliation: Division of Thoracic Surgery, Vancouver General Hospital, Vancouver, British Columbia.
authors.forename: Basil S
authors.initials: BS
authors.lastname: Nasir
authors.affiliation: CHUM Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tahiri
authors.affiliation: Department of Medicine-Pulmonary/Critical Care, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Jordan
authors.initials: J
authors.lastname: Kazakov
authors.affiliation: CHUM Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.affiliation: CHUM Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
authors.affiliation: CHUM Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. Electronic address: moishe.liberman@umontreal.ca.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001982:Bronchial Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult