Timely Airway Stenting Improves Survival in Patients With Malignant Central Airway Obstruction

doi:10.1016/j.athoracsur.2010.06.093

The Annals of Thoracic Surgery

Volume 90, Issue 4, October 2010, Pages 1088-1093

https://doi.org/10.1016/j.athoracsur.2010.06.093 Get rights and content

Background

The survival of patients with malignant central airway obstruction is very limited. Although airway stenting results in significant palliation of symptoms, data regarding improved survival after stenting for advanced thoracic cancer with central airway obstruction are lacking.

Methods

Fifty patients received a total of 72 airway stents for malignant central airway obstruction over a two-year period at a single institution. The Medical Research Council (MRC) dyspnea scale and Eastern Cooperative Oncology Group (ECOG) performance status were used to divide patients into a poor performance group (MRC = 5, ECOG = 4) and an intermediate performance group (MRC ≤4, ECOG ≤3). The SPSS version 16.0 (SPSS Inc, Chicago, IL) and Microsoft Excel (Microsoft, Redmond, WA) were used to analyze the data. Survival curves were constructed using the Kaplan-Meier survival analysis method and a log-rank test was used to compare the survival distributions among different groups.

Results

Successful patency of the airway was achieved in all patients with no procedure-related mortality. Stenting resulted in significant improvement in MRC and ECOG performance scores (p < 0.01). Significantly improved survival was observed only in patients in the intermediate performance group compared with patients in the poor performance group (p < 0.05).

Conclusions

Airway stenting resulted in significant palliation of symptoms in both groups as evaluated by MRC dyspnea scale and ECOG performance status. Compared with historic controls, a significant survival advantage was seen only in the intermediate performance group. We postulate that timely stenting of the airway, before the morbid complications of malignant central airway obstruction have set in, results in improved survival.

Section snippets

Patient Population

A retrospective analysis was performed of all patients with symptomatic malignant central airway obstruction who underwent airway stenting with or without endoscopic tumor resection at a single institution over a two-year period (2007 to 2009). Institutional Review Board approval was obtained (IRB#09-026x). Fifty patients received a total of 72 tracheobronchial stents. The following patients were included.

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Patients with central airway obstruction due to malignancy with at least 75% area

Results

Patient demographics, clinical characteristics, and operative findings are summarized in Table 1. Fifty patients received a total of 72 airway stents over a 2-year period, with 65 stents placed at the initial operation. Thirty-eight patients received a single stent, nine received 2 stents, and three patients received 3 stents at the initial operation. The mean age of the patients was 66 ± 13 years (range, 44 to 89 years) with 29 male and 21 female patients. All patients had either advanced

Comment

In both the intermediate and poor performance groups, airway stenting resulted in significant improvement in symptoms with an acceptably low complication rate. While these data have been reported previously [27, 28, 29, 30, 31, 32, 33], to date we have found no literature regarding the impact of tracheobronchial stenting on improved survival. Historically, survival of patients with untreated malignant central airway obstruction ranges from 1 to 2 months [20, 21]. Airway stenting with or without

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Airway stenting for liberation from positive pressure ventilation in patients with central airway obstruction presenting with acute respiratory failure
2024, Respiratory Medicine
Central airway obstruction (CAO) can lead to acute respiratory failure (RF) necessitating positive pressure ventilation (PPV). The efficacy of airway stenting to aid liberation from PPV in patients with severe acute RF has been scarcely published. We present a systematic review and our recent experience.
A systematic review of PubMed was performed, and a retrospective review of cases performed at our two institutions from 2018 to 2022 in adult patients who needed stent insertion for extrinsic or mixed CAO complicated by RF necessitating PPV.
Fifteen studies were identified with a total of 156 patients. The weighted mean of successful liberation from PPV post-stenting was 84.5% and the median survival was 127.9 days. Our retrospective series included a total of 24 patients. The most common etiology was malignant CAO (83%). The types of PPV used included high-flow nasal cannula (HFNC) (21%), non-invasive ventilation (NIV) (17%) and Invasive Mechanical Ventilation (62%). The overall rate of successful liberation from PPV was 79%, with 55% of HFNC and NIV cases being liberated immediately post-procedure. The median survival of the patients with MCAO that were successfully liberated from PPV was 74 days (n = 16, range 3–893 days), and for those with that failed to be liberated from PPV, it was 22 days (n = 4, range 9–26 days).
In patients presenting with acute RF from extrinsic or mixed morphology CAO requiring PPV, airway stenting can successfully liberate most from the PPV. This may allow patients to receive pathology-directed treatment and better end-of-life care.
Treatment of malignant airway stenosis with extracorporeal membrane oxygenation under low-dose anticoagulation: A case report
2023, Heliyon
The occurrence of airway obstruction due to severe stenosis from lung cancer poses a significant risk of asphyxia. Although the placement of a metallic stent may relieve the obstruction, the procedure is associated with a high risk of asphyxia. To mitigate this risk, extracorporeal membrane pulmonary oxygenation (ECMO) has been proposed to temporarily substitute for cardiopulmonary function during the procedure. However, the use of systemic anticoagulation with heparin during ECMO may increase the likelihood of bleeding during surgery. This case report describes a successful treatment of a patient with malignant central airway obstruction through low-dose heparin veno-venous ECMO. This approach resulted in reduced intraoperative bleeding and invasive operation time, allowing for prompt postoperative withdrawal and recovery.
L'endoscopie interventionnelle (désobstruction et prothèse)
2022, Revue des Maladies Respiratoires Actualites
L’obstruction des voies aériennes proximales (OAVP) surviennent dans 15 à 30 % des cancers du poumon entrainant une altération de la qualité de vie voire une mise en jeu du pronostic vital. L’endoscopie interventionnelle, grâce à différentes techniques, permet de pallier rapidement dans la majorité des cas aux différents symptômes. Ce traitement invasif ne doit être utilisé qu’en cas d’obstruction avec un parenchyme d’aval qui parait viable. Le type de tumeur et les caractéristiques précises du patient sont également à évaluer afin que ces patients présentant une OAVP puissent en tirer le plus de bénéfice.
1877-1203/© 2022 SPLF. Publié par Elsevier Masson SAS. Tous droits réservés.
Proximal airway obstruction occurs in 12-30% of lung cancers. It results an alteration in the quality of life or even a threat to the vital prognosis. Interventional endoscopy thanks to different techniques allows to quickly alleviate the various symptoms in the majority of cases. This invasive treatment should only be used in the event of an obstruction with a downstream parenchyma that appears viable. The type of tumor and the precise characteristics of the patient are also evaluated so that this patients with proximal airway obstruction can derive the most benefit.
1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.
Airway stenting: State of the art
2022, Revue des Maladies Respiratoires
La mise en place de prothèses permet de soulager les symptômes liés aux sténoses des voies aériennes centrales dans l’immense majorité des cas. Elles peuvent être curatives dans un certain nombre de situations non tumorales et offrent un pont vers les traitements locaux ou systémiques dans le contexte des obstructions malignes. Ces 30 dernières années ont vu ce domaine évoluer de manière très importante après le développement des prothèses en silicone dédiées aux voies aériennes dans les années 1990, puis de modèles hybrides métalliques auto-expansibles couverts, avec des gammes de formes de plus en plus variées. Nous revoyons ici les grandes familles de stents, leurs avantages et limites et leurs indications préférentielles d’abord en situation néoplasique mais également pour la gestion des sténoses bénignes des voies aériennes. Les avancées récentes et perspectives, en particulier le développement de prothèses de plus en plus personnalisées ou biodégradables sont également évoquées.
In the overwhelming majority of cases, Airway stents offer relief of malignant or benign central airway obstruction. In some non-tumoral situations, they can be curative, providing a bridge to local or systemic treatments in the context of malignant obstruction. The efficacy and tolerance of these medical devices have dramatically improved over the past three decades with the development of silicone airway stents and, more recently, of third-generation, covered, self-expandable metallic stents with an increasingly widened panel of shapes. We review herein the main categories of airway stents with their specific indications, pitfalls, and advantages, not only in neoplastic situations, but also in the treatment of benign stenoses of the respiratory tract. The recent advances and perspectives in the field are also taken into consideration, particularly the development of biodegradable, drug-eluting, and patient-specific customized AS.
Urgences oncologiques
2021, Revue des Maladies Respiratoires Actualites
Parmi les patients cancéreux, ceux atteints d’un cancer bronchique ont fréquemment recours aux urgences. Environ 40 % des patients atteints de cancer bronchique consulteront aux urgences. Les motifs principaux motivant le patient à se présenter aux urgences sont la fièvre, les plaintes respiratoires, neuropsychiatriques et digestives. L’infection, la progression néoplasique et la douleur sont les 3 principaux diagnostics. Ces complications peuvent être liées au cancer, au traitement antinéoplasique ou non. Ce manuscrit revoit la prise en charge des urgences les plus fréquentes.
© 2021 SPLF. Publié par Elsevier Masson SAS. Tous droits réservés.
Among cancer patients, those with lung cancer frequently use emergencies. About 40% of patients with lung cancer will consult at an emergency room. The main complaints motivating the patient to go to the emergency room are fever, respiratory, neuropsychiatric and digestive symptoms. Infection, neoplastic progression and pain are the 3 main diagnoses. These complications may be related to cancer, antineoplastic treatment or not. This manuscript reviews the management of the most frequent emergencies
© 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.
Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE)
2020, Lung Cancer
Citation Excerpt :
Second, we should consider which is the real advantage in survival following interventional bronchoscopy in stage IIIB NSCLC. Previous studies have analyzed the outcome of NSCLC patients undergoing interventional bronchoscopy in a heterogeneous population, mixing up locally advanced NSCLC and stage IV, without a reliable control group, providing inconclusive results (16–24). Some data suggest that there is no difference in survival between patients free from CAO receiving chemotherapy, compared to those symptomatics who underwent successful interventional bronchoscopy followed by adjuvant chemotherapy (16).
Despite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients.
This retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes.
A total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR = 2.1 95%CI[1.1-4.8], p = 0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months,<0.0001), a lumen occlusion >65% (6.6 VS 2.9 months,<0.001), and lacking the involvement of left bronchus (7 VS 2.3 months,<0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p = 0.03), symptom-free interval (p = 0.02), and onset of atelectasis (p = 0.01).
In patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention.

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Original articleGeneral thoracicTimely Airway Stenting Improves Survival in Patients With Malignant Central Airway Obstruction

Background

Methods

Results

Conclusions

Section snippets

Patient Population

Results

Comment

Chest

Radiol Clin North Am

Ann Thorac Surg

Ann Thorac Surg

J Vasc Interv Radiol

Chest

Ann Thorac Surg

J Vasc Interv Radiol

Chest

Chest

Cancer statistics, 2008CA Cancer

J Clin

Current surgical treatment of non-small cell lung cancer 2001

Eur Respir J Suppl

Lung cancer: the importance of early intervention

Compr Ther

Lung cancer: clinical presentation and specialist referral time

Eur Respir J

Symptoms at presentation for treatment in patients with lung cancer: implications for the evaluation of palliative treatmentThe Medical Research Council (MRC) Lung Cancer Working Party

Br J Cancer

Central airway obstruction

Am J Respir Crit Care Med

Original article
General thoracic
Timely Airway Stenting Improves Survival in Patients With Malignant Central Airway Obstruction