Malignant airway obstruction

Carrasco CH, Nesbitt JC, Charsangavej C, Ryan B, Walsh GL, Yasumori K, Lawrence DD, Wallace S (1994) Management of tracheal and bronchial stenoses with the Gianturco stent. Ann Thorac Surg 58 1012-1016 Cavaliere S, Venuta F, Foccoli P et al. (1996) Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest 110 1536-1542... 

Tanigawa N, Sawada S, Okuda Y, Kobayashi M, Mishima K (2000) Symptomatic improvement in dyspnea following tracheobronchial metallic stenting for malignant airway obstruction. Acta Radiol 41 425-428 Tojo T, lioka S, Kitamura S, Maeda M, Otsuji H, Uchida H, Mori T, Furuse K (1996) Management of malignant tracheobronchial stenosis with metal stents and Dumon stents. Ann Thorac Surg 61 1074-1078... 

Covered metallic stents provide effective treatment for malignant flstulas and perforations. The clinical success rates are very high and most patients derive relief from symptoms of aspiration or debilitating thoracic sepsis. Patients with recurrent flstulas or leaks may be treated by additional overlapping stents in most cases. Metallic stents placed in the airways may be useful for some patients with a dilated esophagus, very high fistulas, or airway obstruction due to local invasion by esophageal tumors. 

Recent technological advances in the last two decades have led to the development of self-expanding or expandable metallic mesh stents. These stents represent the latest technology for the treatment of malignant and benign airway obstructions. A stent can be described as a tubular prosthesis that maintains luminal patency and a predefined luminal diameter of a tubular structure by opposing radial forces to extrinsic or intramural compressive forces. Thus, a stent provides internal support for luminal patency. 

George and colleagues (1992) treated nine patients with malignant central airway obstruction due to tracheal (n=3) or main bronchial ( =6) stenosis with Gianturco stents. All patients suffered from severe dyspnea or asphyxia (four were emergency treatments). All patients had dramatic and rapid reUef of their symptoms after stent insertion. Two patients with intraluminal tumor growth required additional endobronchial measures to control local tumor progression. Patients survived between 3 weeks and 8 months after the intervention. Causes of death were cachexia or pneumonia. 

Patients should be able to cooperate during the procedure. Some patients with severely symptomatic SVCOS may have difficulties in lying flat on the examination table. In these circumstances, the procedure should be undertaken under general anesthesia. A minority of patients will present with simultaneous tracheobronchial narrowing, due to malignant mediastinal compression. Stenting of the airways should precede management of the caval obstruction in such patients. 

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