Clinical outcomes of self-expandable metallic stents for malignant obstructive atelectasis

Abstract

Self-expandable metallic stents (SEMSs) have been widely used in the treatment of malignant central airway obstruction. However, few reports focus on the treatment of atelectasis and how to estimate the prior probability of success via SEMSs placement, This current study aimed to study the safety and effectiveness of SEMSs for the treatment of obstructive atelectasis, and the value of preoperative CT enhancement for ventilation of atelectasis via SEMSs placement. A total of 35 patients with obstructive atelectasis (29 male and 6 female) was included from February 2012 to March 2018. The procedures were performed under fluoroscopic guidance, and bronchoscopic laser resection was performed for severe restenosis cases after SEMSs placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. Thirty-eight SEMSs were successfully implanted in 34 patients, included 29 Y type tracheal stents, 4 small y stents, and 5 straight airway stents. After stenting, 26 cases showed full ventilation, and 3 cases were partially ventilated. The technical success and clinical success was 97.1% and 82.9%, respectively. A higher maximum enhancement CT value was found in patients with full ventilation. Mean follow-up time was 18.8 ± 4.0 months. Eight cases showed restenosis and received endoscopic laser resection, included 1 case underwent removal and 3 cases received second stenting. There were 2 cases of perioperative non-operative death, and 11 cases of post-discharge death (2 cardiac deaths and 9 malignant tumors). The survival rates of 3 months, 1 year and 2 years were 78.6%, 58.5% and 58.5%, respectively. In conclusion, SEMSs placement is safe and effective for obstructive atelectasis, and the preoperative CT enhancement played an important role in estimating the prior probability of success in the treatment of atelectasis via SEMSs placement. Obstructive atelectasis caused by malignant lung or esophageal cancer is a clinical emergency, which is characterized by progressive dyspnea and risk of asphyxiation. Patients often show chronic dyspnea and difficulty to receive surgical resection, chemotherapy, and radiotherapy, thereby resulting in low quality of life and poor prognosis 1. Although SEMSs has been widely used for palliation of airway stenosis, especially malignant central airway obstruction 2-8. At present, few reports have described the treatment of atelectasis via SEMSs placement, except for some case reports 1,9-11. SEMSs implantation can relieve symptoms, improve pulmonary function and stabilize cardiovascular conditions to undertake a successful surgical correction 11. However, stent treatment also brings potential fatal complications, such as stent restenosis caused by tumor or granulation tissue, stent fracture, and stent migration 12-14. Hachiya et al. even reported the potential risk of creating obstructive atelectasis in two cases after stenting 2. Thus it is impo...

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