Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 9, Number 1, January 2017, pages 58-63

Our Clinical Experience of Self-Expanding Metal Stent for Malignant Central Airway Obstruction

Figure

Figure 1.
Figure 1. Representative case of malignant central airway obstruction in a 60-year-old male with squamous cell carcinoma. (A) Complete right lung collapse on the radiograph at the time of initial presentation with the cut off of the right main bronchus (arrow). (B) CT scan of the chest (axial view) showing collapsed right lung. (C) Visible endobronchial tumor obstructing the right main bronchus on bronchoscopy. (D) Re-expansion of the right lung following the SEMS placement in the right main bronchus and bronchus intermedius (arrow). (E) Post-stent placement CT scan of the chest (axial view) showing re-expansion of the right lung and stent in-situ (arrow). (F) CT scan of the chest 1 year later showing tumor ingrowth and recurrence of lung collapse.

Tables

Table 1. General Characteristics of Patients (n = 16)
 
SN/age/genderType of cancerAirway lesionsRadiology findingsSite of stentStent dimensionsOther therapy
RUL: right upper lobe; Rt.: right; LMB: left main bronchus; RMB: right main bronchus; BI: bronchus intermedius; RT: radiotherapy; #: number of fractions of radiotherapy.
Lung cancer (n = 9)
1/78/FNon-small cell carcinomaMid-trachea stenosis4.4 × 3.5 cm mass in superior mediastinum compressing the tracheaMid-trachea16 × 40 mmNil
2/63/MSarcomatoid cancerRMB obstructionRUL massRMB12 × 40 mmRT
3/61/MSquamous cell carcinoma lungRMB and BI obstruction4.5 × 4.7 × 4.6 cm Rt. hilar mass with complete collapse if Rt. lungRMB and BI14 × 40 and 14 × 40 mmRT and chemotherapy
4/58/MAdenocarcinoma lungRMB obstruction12.8 × 7.7 × 7.5 cm RUL mass with SVC obstructionRMB16 × 40 mmNil
5/74/FAdenocarcinoma lungRMB obstructionRUL mass with collapse of RULRMB12 × 40 mmRT (9#)
6/70/MSquamous cell carcinomaMid-tracheal and RMB obstruction-Trachea16 × 40 mmChemotherapy and RT
7/70/MSquamous cell carcinomaDistal trachea, proximal Rt. Main and proximal Lt. main obstructionInfiltrateRight and LMB12 × 40 and 12 × 40 mmRT (35#)
8/77/MSquamous cell carcinoma-RMB10 × 40 mmRT
9/67/FSquamous cell carcinomaDistal trachea narrowing to 0.4 cm and Rt. Main obstruction6.1 × 5.5 × 6.5 cm RUL mass with tracheal compressionDistal trachea16 × 40 mmRT (12#)
Esophageal cancer (n = 5)
10/58/MSquamous cell carcinomaLMB obstruction5.2 × 3.8 × 2.4 cm mass in posterior mediastinumLMB14 × 40 mmIvor-lewis surgery with chemotherapy and RT prior to stenting
11/66/MSquamous cell carcinomaLMB obstruction-LMB14 × 40 mm
12/68/MSquamous cell carcinomaLMB obstruction-LMB14 × 40 mmChemotherapy and RT
13/55/MSquamous cell carcinomaLMB obstruction-LMBChemotherapy
14/63/MAdenocarcinomaLMB esophageal fistulaBilateral infiltrates from aspiration pneumoniaLMB18 × 40 mmIvor-lewis surgery prior to stenting
Thyroid cancer (n = 2)
15/54/FAnaplastic thyroid carcinomaUpper tracheal narrowing to 0.5 cm5.2 × 6.2 × 6.4 cm mass in the thyroid glandUpper tracheaNil
16/76/FAnaplastic thyroid carcinomaSub-glottis and upper tracheal stenosis6.6 × 3.3 × 5.6 cm mass in the thyroid glandUpper trachea18 × 60 mmNil

 

Table 2. Survival of Patients Having Malignant COA and Treated With SEMS in Comparison to the Expected Survival Associated With the Underlying Malignancy (n = 16)
 
Respiratory failureDiagnosis-to-stenting time (days)Diagnosis-to-death time or last follow-up time (actual life expectancy in days)Stenting-to-death or last follow-up (days)Expected life expectancy
*Patients without respiratory failure in the lung carcinoma group underwent stent placement to prevent worsening of the airway obstruction secondary to radiation therapy. Patients without respiratory failure in the esophageal carcinoma group underwent stent placement prior to esophageal stenting to prevent airway compromise from esophageal stenting.
Non-small cell lung cancerYes147460
Sarcomatoid cancerYes40220180
Squamous cell carcinoma lungYes1362361
Adenocarcinoma lungYes395415
Adenocarcinoma lungNo*11347336
Squamous cell carcinomaNo51656448 (alive)
Squamous cell carcinomaYes-12140152 (alive)
Squamous cell carcinomaNo48985 (alive)
Squamous cell carcinomaYes62115 (alive)
Lung cancer (n = 9), median (range)11 (-12 - 516)140 (21 - 564)85 (15 - 361)10 (8 - 12) months [13]
  Squamous cell carcinomaYes32341996
  Squamous cell carcinomaNo29936061
  Squamous cell carcinomaYes117288171
  Squamous cell carcinomaNo20860
  AdenocarcinomaYes5611761
Esophageal cancer (n = 5), median (range)117 (20 - 323)288 (80 - 419)61 (60 - 171)9 (8 - 10) months [15-17]
  Anaplastic thyroid carcinomaYes557116
  Anaplastic thyroid carcinomaYes69187118
Anaplastic thyroid cancer (n = 2), median (range)62 (55 - 69)129 (71 - 187)67 (16 - 118)3.8 (3 - 4.6) months [14]
All (n = 16)39.5 (-12-516)163.5 (21 - 564)73 (15 - 361)

 

Table 3. Complications of Stent Placement in Malignant Central Airway Obstruction
 
McGrath et al [19] (n = 68)Saad et al [20] (n = 82)Cavaliere et al [2] (n = 306)Breitenbucher et al [21] (n = 60)Current study (n = 16)
Type of stentUltraflex SEMSUltraflex SEMSSilicone stentsUltraflex SEMSCovered Ultraflex SEMS
Covered/uncoveredUncovered (94%)Uncovered (66%)Not applicableUncovered (18.3%)Uncovered (0)
Migration4(5.8%)4.7%18 (6%)5%0
Granulation tissue3 (4.4%)14.6%3 (0.9%)5%1 (6.2%)
MucostasisNot reportedNot reported3 (0.9%)8%1 (6.2%)
Tumor ingrowth1 (1.4%)Not reportedNot reported5%2 (12.5%)
Pneumonia2 (2.9%)15.9%5 (1.6%)10%0