Clinical Outcomes with Airway Stents for Proximal versus Distal Malignant Tracheobronchial Obstructions

Abstract

This study evaluates the outcome of tracheobronchial stent placement in symptomatic patients with malignant disease. From 1993 to 2002, 30 patients had stents placed for malignant strictures. Five of 30 patients underwent stent placement distal to the mainstem bronchi, 13 received stents in both the proximal and distal airways, and 12 received stents in only the proximal airways. Clinical response and survival were determined from the patients' medical records. A positive clinical response was judged to have occurred if the patient improved in two of these three categories: subjective symptoms (patient-reported), objective signs (clinician-reported), and postprocedural imaging. The condition of 29 of 30 patients improved within 4 weeks of stent placement. The mean survival duration after stent placement was 261 days (SD, 395.1 days). The location of stent placement was not associated with significant differences in clinical improvement or survival (P =.51). Eight patients had additional airway segments that were too diffusely involved in which to place a stent or could not be recanalized. Mean survival in this group with incomplete stent placement was significantly reduced at 24.9 days (SD, 23.1 days), compared with 345.5 days (SD, 436 days) for the remaining patients who underwent complete stent placement (P <.05). Four patients lived less than 10 days after the procedure and three patients (75%) had mediastinal invasion. Tracheobronchial stent placement effectively palliates malignant airway obstruction, and clinical improvement is independent of the location in which the stent is implanted. When patients had diffuse or highly obstructive airway involvement and underwent incomplete stent placement, clinical response was also satisfactory, even though survival was worse. Patients with mediastinal invasion were poor candidates for stent placement as a result of their short survival.