Malignant central airway obstruction

Mudambi, Lakshmi; Miller, Russell; Eapen, Georgie A.

doi:10.21037/jtd.2017.07.27

Cited by 88 publications

(94 citation statements)

References 115 publications

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“…The frequency of complications may also increase with repeated obstructions. Endobronchial lesions can be treated by mechanical debulking or laser cauterization, but mixed lesions require multimodality therapy to maintain airway patency [31]. Multimodality therapy often increases the incidence of procedure-related complications and patient mortality [27,28].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival after bronchoscopic intervention in patients with airway obstruction due to primary pulmonary malignancy

et al. 2020

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Background: Malignant central airway obstruction (MCAO) occurs in 20-30% of patients with primary pulmonary malignancy. Although bronchoscopic intervention is widely performed to treat MCAO, little data exist on the prognosis of interventional bronchoscopy. Therefore, we evaluated the clinical outcomes and prognostic factors of bronchoscopic interventions in patients with MCAO due to primary pulmonary malignancy. Methods: This retrospective study was conducted at a university hospital and included 224 patients who received interventional bronchoscopy from 2004 to 2017, excluding patients with salivary gland-type tumor. A multivariable Cox proportional hazard regression analysis was used to identify independent prognostic factors associated with survival after the first bronchoscopic intervention. Results: Among 224 patients, 191 (85.3%) were males, and the median age was 63 years. The most common histological type of malignancy was squamous cell carcinoma (71.0%). Technical success was achieved in 93.7% of patients. Acute complications and procedure-related death occurred in 15.6 and 1.3% of patients, respectively. The median survival time was 7.0 months, and survival rates at one year and two years were 39.7 and 28.3%, respectively. Poor survival was associated with underlying chronic pulmonary disease, poor performance status, extended lesion, extrinsic or mixed lesion, and MCAO due to disease progression and not receiving adjuvant treatment after bronchoscopic intervention. Conclusions: Interventional bronchoscopy could be a safe and effective procedure for patients who have MCAO due to primary pulmonary malignancy. In addition, we found several prognostic factors for poor survival after intervention, which will help clinicians determine the best candidates for bronchoscopic intervention.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival after bronchoscopic intervention in patients with airway obstruction due to primary pulmonary malignancy

et al. 2020

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“…Various malignances can occur in the carinal region including the lower trachea and the proximal end of the bilateral main bronchus (1). Dyspnea, cough and hemoptysis are commonbut nonspecific respiratory symptoms (17). Since the majority of patients are already in the advanced stages of the disease at the time of diagnosis, only a number of patients have the opportunity for surgical treatment (3).…”

Section: Discussionmentioning

confidence: 99%

Application of Micro‑Tech stents in malignant carinal stenosis

et al. 2019

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Malignant carinal stenosis is a disease process that is not always suitable for treatment with a Y-shaped stent. When one of the main bronchi is completely obstructed and cannot be recanalized, or its distal lung tissue has lost function, inserting a Y-shaped stent is infeasible. In this complex condition, a cone-shaped stent is selected to maintain the patency of the trachea and the other main bronchus. The efficacy of the bare cone-shaped Micro-Tech stent to treat malignant carinal stenosis was evaluated in the current study. The medical records of 47 patients with malignant carinal stenosis who underwent Micro-Tech stent placement between January 2004 and October 2017 in Beijing Tian Tan Hospital (Beijing, China) were analyzed retrospectively. A total of 47 bare Micro-Tech stents (28 Y-shaped and 19 cone-shaped) were successfully inserted in the patients. Following stent placement, immediate satisfactory results were achieved in all patients, especially an improvement of dyspnea (100%), cough (81.1%) and stridor (100%). The Karnofsky scores were significantly increased (P<0.001), and the American Thoracic Society Dyspnea Index values were significantly decreased (P<0.001). Following a median of 88 days, initial bronchoscopic interventions were performed for tumor overgrowth (84.6%), stent fracture (7.7%) and granulation tissue (7.7%). Restenting was performed in two patients due to tumor progression (n=1) and stent fracture (n=1). Removal of a Y-shaped stent was attempted in one patient, but failed, as the stent had become partly embedded in the airway mucosa. In conclusion, cone-shaped Micro-Tech stent placement maintained tracheal-unilateral main bronchus patency and benefitted patients with malignant carinal stenosis in whom Y-shaped stents were not suitable for insertion.

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“…Malign hava yolu obstrüksiyonu en sık akciğer kanseri ve ösefagus malignitelerinin komplikasyonu olarak karşımıza çıkmaktadır. Akciğer kanserine bağlı tra-kea ve ana bronşlarda obstrüksiyonu olguların %20 -30'unda geliştiği bildirilmiştir (48,49) . (49) .…”

Section: Akut Hava Yolu Obtrüksi̇yonuunclassified

Emergencies in Lung Cancer

Gümüş¹,

Özyurt²

2018

GGHS

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İnsanlarda beklenen ortalama yaşam süresinin artmasıyla birlikte kanser vakalarında da artışlar görülmektedir. Özellikle akciğer kanserinin görülme sıklığı ve mortalitesi dünya çapında artmaya devam etmektedir. Bu hastalarda sıklıkla akut ciddi semptomlar ve yaşamı tehdit eden durumlar ortaya çıkmakta ve acil tıbbi bakım gerekmektedir. Akciğer kanserinde acil servise başvuru ve mortalite diğer solit tümörlerden daha fazla görülmektedir. Bu acil durumlar kanserle direkt veya dolaylı olarak ya da tümörün tedavisi ile ortaya çıkar ve potansiyel olarak yaşamı tehdit eder. Tümörün bölgesel yayılımı ilişkili olarak vena kava süperior sendromu, perikardiyal tamponat, masif hemoptizi, massif plevral efüzyon ve akut hava yolu obstrüksiyonu görülmektedir. Hiperkalsemi, hiponatremi, uygunsuz ADH salınımı sendromu ve tümör lizis sendromu ise akciğer kanserinde ortaya çıkan metabolik acil durumlardır. Beyin metastazları, kemik metastazları ve spinal kord basısı uzak metastazlara bağlı olarak ortaya çıkmaktadır. Ayrıca, bu hastalarda kemoterapiye bağlı olarak febril nötropeni, hipersensitivite reaksiyonları ve anaflaksi, radyoterapiye bağlı olarak akut radyasyon pnömonitisi ve özefajit ortaya çıkmaktadır. Onkolojik aciller hayatı tehtit eder ve mortalitesi yüksektir. Mortalite ve morbiditeyi azaltmak için erken tanı ve tedavi büyük önem taşır. Çünkü tanı ve tedavide gecikmeler çoğu zaman ölümle sonuçlanabilmektedir.

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Malignant central airway obstruction

Cited by 88 publications

References 115 publications

Prognostic factors for survival after bronchoscopic intervention in patients with airway obstruction due to primary pulmonary malignancy

Prognostic factors for survival after bronchoscopic intervention in patients with airway obstruction due to primary pulmonary malignancy

Application of Micro‑Tech stents in malignant carinal stenosis

Emergencies in Lung Cancer

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