XXXX stents in the management of inoperable tracheobronchial stenoses. Indications and limitations.

@entity1 @entity1353 @entity5 @entity1544 @entity1346 @entity1282 @entity7867
BACKGROUND: Various stent models have been developed for the treatment of inoperable stenoses of the central airways caused by external compression. Increasing use is made of the silicone stents designed by Dumon. We tested their technical feasibility, tolerance, and long-term efficacy in relieving respiratory symptoms in @entity1 referred for endoscopic palliation of @entity5 . METHODS: All procedures were performed under general anesthesia with the use of the rigid bronchoscope. We inserted 38 stents in 31 @entity1 (median age, 67 years; 25 @entity1 and 6 @entity1 ) whose airways showed residual obstruction of > 50 percent of the lumen after laser resection of @entity5 and/or mechanical dilatation of extrinsic compressions. RESULTS: Stent placement and removal--where necessary--were easy in all @entity1 , but five stents inserted in three @entity1 with short (< or = 2.5 cm) and conical stenoses migrated, necessitating emergency removal. In 27 of the remaining 28 @entity1 , stent tolerance was excellent; 1 proximal tracheal stent (< 1 cm below the vocal cords) had to be removed because of @entity7867 and @entity1282 . One lethal hemoptysis occurred within hours after a repeated laser therapy and removal of an indwelling stent. No other serious complications occurred. Immediate and lasting relief of @entity1353 and improvement in performance status (Karnofsky scale, activity index) was achieved in 90 percent (28/31) of @entity1 (p < 0.01). The influence of adjuvant radiotherapy on @entity5 recurrence and survival was analyzed in a subgroup of ten @entity1 with @entity1544 with comparable performance status. Five did not undergo adjuvant radiotherapy (group A) and five did (group B). In group A, four of five stents were occluded by @entity5 recurrence above or below the stent after a median follow-up of 2 months; in group B, zero of five were occluded (p < 0.05) after 4 months. Median survival was 4 months in group A and 6 months in group B; the difference did not reach significance. CONCLUSIONS: The @entity1346 stents designed by Dumon are easily inserted and removed; they are also well tolerated and very efficacious in relieving respiratory symptoms caused by extrinsic airway compression. Short and conical stenoses present limitations for their use due to increased risk of migration. Combined treatment with laser resection, stent insertion, and subsequent radiotherapy is necessary to prevent @entity5 recurrence and may improve survival.
