Long-Term Follow-Up and Survival after UltraflexTM Stent Insertion in the Management of Complex Malignant Airway Stenoses

Abstract

Background: Despite being commercially available for a few years now, the literature regarding the outcome of UltraflexTM stent insertion in complex malignant airway stenoses is sparse. Objectives: To assess long-term complications and survival in patients with complex malignant airway stenoses treated with insertion of nitinol stents. Methods: 60 consecutive patients with UltraflexTM stent insertion for malignant airway stenoses were included. Follow-up was obtained in all patients. Results: 62 UltraflexTM stents (covered = 51, uncovered = 11) were implanted in 60 patients. Diagnoses were bronchial carcinoma (n = 50), esophageal carcinoma (n = 3) and metastases (n = 7). Stents were inserted in the trachea (n = 5), main bronchi/intermediate bronchus (n = 22), from main bronchi/intermediate bronchus to lobar bronchi (n = 28) or in the lobar bronchi themselves (n = 7). Successful reopening of the stenoses and relief were achieved in all patients. There was no procedure-related mortality. Complications included mucous plugging in 8%, stenosing granulation tissue in 5%, tumor ingrowth in 5% and stent migration in 5% of patients. Using Kaplan-Meier estimates, the overall mean survival was 160 days (standard error: 30). Median survival was 91 days. The overall 3- and 6-month survival were 52 and 20%, respectively. Death (n = 59, 98%) was attributed mainly to disease progression with cachexia and metastases, pneumonia (n = 5, 10%), and hemoptysis (n = 1, 2%). Conclusion: UltraflexTM stents have a low complication rate and can be effectively used in complex malignant airway stenoseswith marked asymmetry or irregularity, angulation or changing diameters.

Stents Are Associated With Increased Risk of Respiratory Infections in Patients Undergoing Airway Interventions for Malignant Airways Disease

“…We classifi ed respiratory infections using a method similar to those of previously published studies. [3][4][5][6][7][8] We defi ned a lower respiratory tract infection as present on the basis of clinical fi ndings of fever, purulent sputum, and worsening cough, with or without radiographic evidence of pneumonia. We also required that there be documentation by the managing physician of a clinical diagnosis of lower respiratory tract infection and that antibiotics be prescribed for it.…”

“…Most other studies of infection in patients undergoing therapeutic bronchoscopy have used incidence proportions. [3][4][5][6][7][8][12][13][14] As we have shown in our previous work, incidence proportions have signifi cant limitations when used to analyze long-term complications; the incidence rate is a more appropriate measurement because it measures events per persontime at risk. 9 An additional benefi t of using survival analysis methods with time-varying covariates is that we can control for factors that vary over time, such as the degree of airway obstruction and stent removal.…”

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

“…[13][14][15][16][17][18] Reported complication rates are low, but complications and outcomes diff er signifi cantly depending on the indication for the procedure (ie, malignant vs benign disease, isolated hemoptysis vs central airway obstruction), and in most studies, signifi cant heterogeneity existed in terms of patient population and indications. 1,4 Many of these studies focused on individual technologies, such as stents, microdebriders, or APC, and most were performed at centers of excellence as part of ongoing research programs.…”

The use of self-expandable metallic stents in the airways in the adult population

“…The last 5 mm on each end of the partially covered stents are uncovered and hold the stent in place; this type is the most popular (FIGURE 1). They have been used for the treatment of malignant and benign stenoses [25][26][27][28][29]. As the expansion force of the knitted nitinol stent is not very high [24,30], sufficient pre-dilatation is required to accomplish good airway patency.…”

“…Usually, benefits noted after successful bronchoscopic treatment of obstruction last for 2-3 months [36]. Benefit duration after stent placement is generally reported to be around 4 months [42].In malignant conditions, silicone stents or SEMS show an identical efficacy and safety profile [22,29,43] because of the too short life expectancy to discern any significant differences in long-term complications caused by different types of stents. In addition, removability of stents, unlike in benign indications, is not the objective in malignancy where palliation is the goal.…”