Secondary Carina and Lobar Bronchi Stenting in Patients with Advanced Lung Cancer: Is It Worth the Effort? A Clinical Experience

Abstract

Background: The lobar airway stenting remains an endoscopic procedure not well standardized in patients with locally advanced lung cancer disease. The goal of this study was to evaluate technical feasibility, clinical outcome, and complications of different stents in patients with malignant lesions involving lobar bronchi, primary and secondary carina. Methods: Between November 2008 and October 2013, we retrospectively analyzed 146 patients with benign and malignant tracheobronchial stenosis who underwent airway stent insertion below main carina and main bronchi. Results: In all, 170 airway stenting procedures were performed on 146 patients. In all, 51 of them with malignant peripheral airway stenosis underwent stents placement below main carina. In all but one patient, the deployment of stents was successful with improvement of symptoms. The chest radiograph after the procedure detected the lung re-expansion in 29 of 51 patients. The mean follow-up duration was 123 days ± 157. Complications observed included stent migration, tumor overgrowth, infections, granulation tissue formation, and obstruction due to tenacious secretions. Longer survival was observed in patients who received additional treatment after airway stenting compared to those who did not (p <0.01). Conclusions: Stenting of lobar bronchi and primary or secondary carina is technically feasible, effective, and acceptably safe.

Advancements in airway stents: a comprehensive update

“…DiBardino et al, however published a study where lung transplant patients did not find benefit, but this was a small group of five patients [13]. A retrospective study by Marchese et al reported outcomes of 51 patients with malignant stenosis at secondary carinae and lobar airways [6]. Improvement was noted in mMRC (2.6 AE 0.8 vs. 1.2 AE 0.5; P < 0.01) with a small number of complications; migration in 11% was most common.…”

“…Predictors of clinical success, specifically among malignant airway obstruction (MAO) have been reported [4]. Stenting is typically considered only for trachea and main bronchi, but evolving literature has described the benefit of lobar stenting in selected patients [5][6][7][8]. Nonmalignant obstruction tends to be more complex ranging from endobronchial inflammation, scars to loss of cartilaginous airway support or malacia.…”

Malignant Airway Obstruction and Endobronchial Stent Placement: A Systematic Review on the Efficacy and Safety

“…Marchese et al (2020) conducted a retrospective chart review involving 51 patients with advanced unresectable lung cancer. The mean age was 67, with 41 males and 10 females [ 16 ]. Marchioni et al (2020) conducted a multicentric retrospective study with 100 patients with central airway obstruction, focusing on integrated treatment (60 patients) versus standard treatment (40 patients).…”

“…The location of the lesion and obstruction was categorized based on different areas, including the trachea, main right bronchus, main left bronchus, carina, and extensive involvement. The degree of obstruction (IQR) for each category was reported, while no additional information was provided regarding dyspnea grade, stenosis type, or blood gas parameters [ 16 ]. Miyazawa et al reported pulmonary function testing results in their study, including vital capacity (VC), forced vital capacity (FVC), peak expiratory flow (PEF), and various stenosis types.…”

“…Both metallic and silicone stents were used, with a total of 52 stents placed. Post-procedural treatment included chemotherapy in 33 patients, radiotherapy in two patients, and surgery in four patients [ 16 ]. Marchioni et al conducted a study where stenting procedures were performed using a Dumon rigid bronchoscope under general anesthesia.…”