Bronchoscopic Management of Patients With Symptomatic Airway Stenosis and Prognostic Factors for Survival

Okiror, Lawrence; Jiang, Li; Oswald, Nicola; Billè, Andrea; Rajesh, P.; Bishay, Ehab; Steyn, Richard; Naidu, Babu; Kalkat, Maninder

doi:10.1016/j.athoracsur.2015.01.061

Cited by 23 publications

(22 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Median 5-year survival in patients with thyroid malignancy was 74.2% [range, <10% after shave resection (29) to 100%]. (6)(7)(8)17,36,53,58,73,121,(125)(126)(127)(128)(129)(130)(131)(132)(133)(134)] …”

mentioning

confidence: 99%

Secondary tracheal tumors: a systematic review

Madariaga¹,

Gaissert²

2018

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: Secondary tracheal tumors arise from mural invasion by primary tumors in adjacent organs, metastatic lymph nodes or blood-born metastasis from distant sites. This systematic review aims to assess the presentation, management options, and clinical outcomes of these uncommon non-tracheal malignancies.Methods: Electronic searches of the MEDLINE database were performed to identify case series and individual case reports of tracheal invasion by primary non-tracheal tumors or metastatic disease. AllEnglish-language studies with available abstracts or articles containing primary data were included.Results: From 1978 to 2017, a total of 160 case reports or case series identified 2,242 patients with invasion of the trachea by tumors of adjacent organs (n=1,853) or by metastatic lymph nodes or hematogenous spread (n=389). Common primary sites of origin were thyroid, esophagus, and lung, and the most common presentation was metachronous (range of interval: 0 to 564 months) with dyspnea, neck mass, voice change and/or hemoptysis. A majority of patients in case reports (77.9%) and case series (66.0%) underwent resection and the most common reported operation was segmental tracheal resection. Fewer patients underwent bronchoscopic intervention (21.7%) and radiation was used in 32.2% of patients. Complications after bronchoscopic treatment included bleeding, granulation tissue, and retained secretions, while anastomotic leak, unplanned tracheostomy, and new recurrent laryngeal nerve paralysis were observed after surgical resection. The rate of 30-day mortality was low (0.01-1.80%). Median survival was higher in patients with thyroid malignancy and in patients who underwent surgical management. Follow-up time ranged from 0.03 to 183 months. Conclusions:Patients with tracheal invasion by metastatic or primary non-tracheal malignancies should be assessed for symptoms, tumor grade, tumor recurrence and concurrent metastases to decide on optimal surgical, bronchoscopic or noninterventional therapy. Clinical experience suggests that palliative endoscopic intervention for tracheal obstruction by metastasis-bearing lymph nodes is underreported.Keywords: Endotracheal metastasis; secondary tracheal tumors; systematic review Submitted Nov 24, 2017. Accepted for publication Dec 21, 2017Dec 21, . doi: 10.21037/acs.2018 View this article at: http://dx.doi.org/10.21037/acs.2018.02.01 Systematic Review IntroductionSecondary tracheal tumors are defined as tumors in, but not of the trachea and comprise a wide spectrum of tumor histologies and stages. There are no populationbased data for these tumors, and in clinical practice these lesions are probably more common than primary neoplasms. A thoracic surgeon probably encounters tracheal obstruction by metastatic lymph nodes more often than invasion by adjacent primary tumors. Since natural history and prognosis are related to the tumor of origin, their management and prognosis may differ considerably from primary tracheal neoplasms; a correct diagnosis with attribution to the origi...

show abstract

mentioning

confidence: 99%

Secondary tracheal tumors: a systematic review

Madariaga¹,

Gaissert²

2018

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…These patients underwent multimodality therapy including tumor ablation with laser, APC, and electrocautery, balloon dilation, and airway stenting [Noppen et al 1997;Brichet et al 1999;Mughal et al 2005;Freitag et al 1997;Ost et al 2014;Okiror et al 2015]. Although large, randomized, controlled trials are lacking, retrospective and prospective data show notable improvement in patients' outcome and quality of life with CAO bronchoscopic management [Jeon et al 2006;Ernst et al 2004].…”

Section: Discussionmentioning

confidence: 99%

Reporting of Central Airway Obstruction on Radiology Reports and Impact on Bronchoscopic Airway Interventions and Patient Outcomes

Harris

Modi

Alraiyes

et al. 2015

Chest

View full text Add to dashboard Cite

“…There is also the case where after oral intubation a stenosis is formed in the trachea and stent placement is necessary 2. Moreover, it has been observed that the reason for this stenosis is based on multiple factors, such as time of intubation which is associated with prolonged time of local stress on the tracheal wall and underlying diseases such as angiitis/chronic obstructive disease and asthma 4–6. There are two major types of stents, silicon and metallic stents which are self-expanding, covered or not.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, stents can be introduced using a variety of techniques under general or mild anesthesia, the choice based on the treating physicians’ experience, medical underlying disease, and the centers’ available equipment 7,8. Regarding patients with malignancy, some prognostic factors such as stridor and postprocedure chemotherapy have been identified as independent prognostic factors 6,9. It is essentially clear that stenting in patient airways is performed antegrade.…”

Section: Introductionmentioning

confidence: 99%

A retrograde y-stenting of the trachea for treatment of mediastinal fistula in an unusual situation

Hohenforst-Schmidt¹,

Steinheimer²,

Schneider³

et al. 2017

TCRM

View full text Add to dashboard Cite

IntroductionStents have been used for quite some time for the treatment of benign and malignant airway stenosis. Silicon stents are preferred for benign situations, whereas metallic self-expanding stents are preferred for malignant comorbidities.Patient and methodsIn general, stents can be placed in different approach directions, although in pulmonary medicine it is logical to apply only antegrade techniques – until now. A 63-year-old patient, 168 cm height and 53 kg weight on referral, suffered chronical diseases. The patient was diagnosed with a papillary thyroid carcinoma in 1989, which was treated by resection and radiotherapy. In the following years, she developed a stenosis of the esophagus. The decision to try endobronchial stenting was made upon the plan to close that fistula with a pedicled omentum majus replacement through the diaphragmal opening of the esophagus. This surgical plastic needed an abutment and a secured continuous airway replacement above the tracheostoma level. A Freitag stent (FS), 11 cm in length (110–25–40) and an inner diameter of 13 mm, was placed successfully retrograde into the trachea and completely bridged the big fistula. Unfortunately the patient passed away due to pulmonary infections after several weeks.DiscussionIn this case report, a successful but unusual case of retrograde stent placement of a modified FS is presented.

show abstract

Bronchoscopic Management of Patients With Symptomatic Airway Stenosis and Prognostic Factors for Survival

Cited by 23 publications

References 11 publications

Secondary tracheal tumors: a systematic review

Secondary tracheal tumors: a systematic review

Reporting of Central Airway Obstruction on Radiology Reports and Impact on Bronchoscopic Airway Interventions and Patient Outcomes

A retrograde y-stenting of the trachea for treatment of mediastinal fistula in an unusual situation

Contact Info

Product

Resources

About