Silicone Stent Versus Fully Covered Metallic Stent in Malignant Central Airway Stenosis

Abstract

Airway stenting to restore airway patency in cases of malignant central airway obstruction is an effective palliation treatment. Our goal was to compare the efficacy after deployment and complications of a fully covered self-expandable metal stent (SEMS) (Aerstent) and a silicone stent (Dumon). This was a retrospective cohort of 2 similar groups of patients with malignant central airway obstruction treated with stents between August 2012 and July 2017. Complications were assessed bronchoscopically. A competing risk for death analysis was performed to adjust the probability of developing a complication. Seventy patients (29 with silicone stents and 41 with SEMS) were included. Stent insertion was successful in all cases. Mucus retention was the most frequent complication (75.9% with silicone stents and 84.8% with SEMS; P= .51), followed by granulation tissue (51.7% with silicone stents and 41.3% with SEMS; P= .52) and migration (6.9% with silicone stents and 13.0% with SEMS; P= .47). In the first month, the cumulative incidence of a complication was 36.7% for silicone stents and 41.3% for SEMS and increased to 90.0% and 97.8% after 6 months, respectively (hazard ratio= 1.66; P= .04). A competing risk for death analysis showed an adjusted hazard ratio of 1.41 (P= .49) indicating no differences in overall complications between stents. Both stents were equally successful and safe. The incidence of complications increased over time to 90% at 6 months for both stents. The risk of overall complications was higher for SEMS; nevertheless, when mortality was measured in a competitive risk analysis, no differences were found between SEMS and silicone stents.