Background Lung cancer is the commonest form of malignant disease in the Western World, and 95% of patients die within 5 years of presentation. Palliation of symptoms is therefore an important aspect of the treatment: up to 30% will develop large airway obstruction due to tumour with ensuing distressing breathlessness and this may be life threatening. Protection of the airway by stenting may be difficult and is traditionally carried out under general anaesthesia and fluoroscopy. In our regional unit we have developed a service for the insertion of self-expanding Gianturco stents under local anaesthesia using the fibreoptic bronchoscope (FOB) and direct vision for the treatment of malignant airway tumours, and we now report our 20-year experience.
Methods A review of all stenting procedures carried out in our unit between 1990 and 2009, looking for tumour type, number and site of stents, procedure complications, and survival.
Results 236 patients (mean age 64 years (range 21–89)) had 414 stents inserted during 242 procedures (mean 1.7 stents/procedure (1–4)); 184 patients for primary lung tumours (49% squamous cell, 25% small cell, 15% adenocarcinoma, 11% unknown), 33 for secondary malignancy, and four for benign conditions (following fully informed consent). There were no operative deaths, but four patients developed a pneumothorax, three haemoptysis, and two procedure-related chest infections. Mean survival of patients with primary lung cancer improved from 103 days (range 1–488) between 1990 and 1999 to 150 days (5–910) between 2000 and 2009.
Conclusion We conclude that Gianturco stents are safe in relieving malignant airway obstruction, with a low complication rate: higher complication rates reported in others studies may be due to poor patient selection or stent placement. Survival improved in our patients over time, suggesting better patient selection or improvement in coexisting treatment modalities (eg, oral chemotherapy and palliative care). Our technique of endobronchial stent insertion using FOB is simple and effective without the need for thoracic surgical facilities, and we therefore recommend its use to other clinicians who are charged with treating patients with this common and distressing disease.