CUSTOMIZING AIRWAY STENT FOR MULTICENTRIC MALIGNANT AIRWAY OBSTRUCTION

Abstract

TYPE: Abstract Publication TOPIC: Procedures PURPOSE: A middle-aged man with adenocarcinoma of sigmoid colon and solitary liver metastasis underwent neoadjuvant chemotherapy followed by hemicolectomy and hepatectomy. The cancer progressed and he developed endobronchial metastasis resulting in near-total obstruction of left main bronchus (LMB) and bilateral pulmonary nodules. METHODS: Laser photoresection of LMB tumor was performed followed by covered self-expanding metallic stent (SeMS). He received radiation and anti-angiogenic therapy. Six months later, he complained of worsening dyspnea and stridor. CT Thorax revealed complete occlusion of the distal end of stent with collapse of left lung. Rigid bronchoscopy revealed tumor in-growth through the stent; tumor at the main carina causing 70% obstruction of the right main bronchus (RMB), and a polypoidal mass arising from the right middle lobe bronchus. Tumor debulking was performed within the stent and at the carina with argon plasma coagulation (APC) and rigid forceps, and the polypoidal mass was removed with electrosurgical snare. The left limb of silicone Y stent was cut to accommodate the SeMS while another circular cut was made just beyond the take-off of the right limb. The right limb of Y stent was deployed into bronchus intermedius, the circular cut maintained aeration to the right upper lobe (RUL). Post procedural CXR showed re-expansion of the left lung with satisfactory position of the silicon and SeMS stents. RESULTS: Figure 1. Bronchoscopic images CONCLUSIONS: Complex Airway Obstruction interferes with airflow and insertion of airway stents provide relief and complement ablative techniques. Modification of stents may prove to be beneficial to these patients. CLINICAL IMPLICATIONS: Please refer above DISCLOSURE: No significant relationships. KEYWORDS: central airway obstruction, airway stent