Tracheobronchial Self-expanding Metallic Stents in Patients With Central Airways Obstruction

Central airway stenosis or fistula in cancer patients is difficult to manage and is associated with poor outcome. We sought to identify the risks and benefits of tracheobronchial self-expanding metallic stents (SEMSs). Records of 46 SEMSs placed in 41 patients for malignant or benign central airway disease from August 2000 to August 2007 were retrospectively analyzed. There was no intraoperative mortality. Technical problems included distal dislodgement, difficulty to initiate deployment, failure of complete deployment, and proximal migration. Of the 38 patients with malignant stenosis and/or fistula, 12 patients (31.6%) developed significant bacterial colonization of airways, along with pneumonia or febrile illness. Tumor ingrowth and nonobstructive granulation were noted on the surveillance bronchoscopy in 6 and 2 patients, respectively. Seventy-five percent of the complications occurred within the first 30 days. Clinical improvement after stenting was observed in 31 patients (81.6%). The causes of inefficacy included diffuse tracheobronchial stenoses, serial laryngotracheal stenoses, long standing lobar collapse, and coexisting severe chronic obstructive pulmonary disease. The median survival after stenting was 47 days (range, 4 to 682 d), with the shortest survival among nonsmall cell lung cancer patients. Three patients with benign airway disease received SEMS after thoroughly exploring all other treatment options. Their indications included severe postintubation subglottic stenosis, posttracheostomy tracheal stenosis, and postoperative tracheo-colon tube fistula. From these results, the majority of complications in patients receiving SEMS for malignant airway disease ensued within 30 days. The relatively short survival after stenting should raise the question if these patients really profited from intervention.