Tracheobronchial stents in palliative care: a case series and literature review

• Published in: BMJ supportive & palliative care Vol. 8; no. 3; pp. 335 - 339
• Main Authors: Tjahjono, Richard, Chin, Ronald Yoon-Kong, Flynn, Peter
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2018
• Subjects: Aged; Airway management; Airway Obstruction - etiology; Airway Obstruction - surgery; Bronchoscopy - methods; Cancer therapies; Cardiovascular disease; Chemotherapy; Chronic obstructive pulmonary disease; Consent; Diabetes; Dyspnea; Endoscopy; Female; Health surveillance; Humans; Hypertension; Literature reviews; Lung cancer; Male; Medical imaging; Metastasis; Middle Aged; Palliative care; Palliative Care - methods; Patients; Quality of life; Respiratory Tract Neoplasms - complications; Respiratory Tract Neoplasms - therapy; Retrospective Studies; Statistical analysis; Stents; Thoracic surgery; Thyroid cancer; Trachea - surgery; Tracheotomy - methods; Treatment Outcome; head and neck; tracheobronchial stent; quality of life; dyspnoea; supportive care
• ISSN: 2045-435X; 2045-4368
• DOI: 10.1136/bmjspcare-2018-001522

ObjectiveTo evaluate the outcomes of tracheobronchial stenting in patients with malignant central airway obstruction and assist practitioners in palliative settings in understanding the indications, contraindications and management of tracheobronchial stents.MethodsThis retrospective study involved a consecutive case series of palliative patients with central airway obstruction secondary to inoperable cancers who underwent tracheobronchial stenting at a single institution. The European Cooperative Oncology Group (ECOG) scale was used to evaluate patient functional status before and after tracheobronchial stenting.ResultsTwenty-three patients underwent tracheobronchial stenting for malignant central airway obstruction. The majority of patients presented with symptoms of worsening dyspnoea (21 of 23; 91%). Postoperatively, there was a significant improvement in mean ECOG performance status from 2.88±0.34 to 1.58±0.50 (p<0.01). There was no intraoperative mortality resulting from tracheobronchial stenting. Five patients (21.74%) re-presented to hospital due to worsening symptoms and required emergency bronchoscopy. Two patients had stent migration, requiring stent replacement. One patient restenosed from tumour granulation, requiring microdebrider to debulk the mass. Two patients had stent failure secondary to external tumour compression, leading to death.ConclusionTracheobronchial stenting is a safe and effective procedure that offers rapid palliation of symptoms and improvement in patient functional status.