P3.02a-035 Can Airway Stenting Avoid Suffocation Deaths Caused by Malignant Airway Obstruction?: Topic: Miscellaneous

Abstract

Airway stenting is undoubtedly the mainstay procedure for treating patients with malignant airway stenosis to prevent a variety of airway symptoms. Suffocation death is the most painful ending for those patients. The impact of airway stent treatment to avoid this tragic event was investigated. Between 2000 and 2014, 57 patients underwent airway stenting in our department for malignant airway stenosis. They included 25 lung cancer cases, 15 esophageal cancer cases and 7 thyroid cancer cases. The location of the stenosis was the carina for 31 cases, the right or left main bronchus in 12, and the trachea 14. Either Dumon silicon (n=50) or self-expandable metallic stents (n=7) were used. The effect of airway stenting to prevent suffocation death, and the factors for predicting the prognosis were analyzed. There were no cases of in-hospital death. An improvement in airway symptoms was achieved in 54 patients (94.7%) and the median survival after stenting was 3.7 months. At death, only 8 (14%) of those patients died due to direct airway symptoms, including respiration difficulty, even when their general condition was good (Suffocation death group). Conversely, the other 49 patients mostly died due to systemic cancer spread, but all 49 cases had no pain associated with airway symptoms. Therefore, suffocation death appears to have been avoided in those 49 (85.9%) patients (Non-suffocation death group). In a univariate analysis, “Stent migration,” “Tracheal stenosis,” and “Thyroid cancer” were potentially significant factors regarding suffocation death. In a multivariate analysis, “Stenosis at mid trachea” was found to be an independent predictive factor for suffocation death (p = 0.02). Suffocation death can be effectively prevented by the use of airway stenting treatment. “Stenosis at mid trachea” is the most problematic factor when attempting to obtain some benefit from stenting and this may be due to the difficulty of achieving accurate stent (mainly straight silicon stent) fixation in such lesions.