Predictors of survival and technical success of bronchoscopic interventions in malignant airway obstruction

Freitas, Cláudia de; Serino, Mariana; Cardoso, Catarina; Saleiro, Sandra; Vaz, Ana Paula; Bastos, Hélder Novais; Morais, António Pedro; Magalhães, Adriana; Fernandes, Gabriela

doi:10.21037/jtd-21-1393

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…The reported frequency of complications during/after TBI is in the range of 5% to 37%. [2][3][4]8,10,11 In the present study, the complication rate during/after the TBI was 26% in the elderly group and 30% in the nonelderly group, with no significant difference between the 2 groups (P = 0.706). In addition, there was no difference in the percentage of patients who showed successful airway recanalization or improvement of symptoms after TBIs between the 2 groups.…”

Section: Discussioncontrasting

confidence: 42%

“…Numerous reports have suggested that TBIs are well tolerated and effective in patients with MCAO and that additional anticancer therapy administered after TBI improves the prognosis of these patients. [5][6][7][8][9][10][11] The median and mean ages of the patients in the abovementioned reports are in the range of 61 to 72 years. In clinical practice, TBIs are performed as an emergent procedure to avoid the risk of suffocation in nonelderly patients with MCAO, but it is unclear whether TBIs are also feasible, well tolerated and effective in elderly patients with MCAO.…”

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confidence: 99%

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confidence: 99%

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Feasibility, Tolerability, and Effectiveness of Transbronchial Interventions in Elderly Patients With Malignant Central Airway Obstruction

Kashiwabara,

Fujii,

Tsumura

et al. 2024

American Journal of Clinical Oncology

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Background: In elderly patients with malignant central airway obstruction (MCAO), the treating physicians often hesitate to undertake transbronchial interventions (TBIs) as a palliative procedure in view of the advanced age of the patients. Methods: We conducted this retrospective study to evaluate the differences in the feasibility, tolerability, and effectiveness of TBIs between elderly (aged 75 years old or above; elderly group; n=27) and nonelderly (aged below 75 years old; nonelderly group; n=50) patients with MCAO. The primary endpoint was the incidence of complications during (within 24 hours) and after (>24 hours) TBIs. Results: The mean age of the patients was 81 years in the elderly group and 61 years in the nonelderly group. The complications encountered during/after TBI included endobronchial bleeding or hypoxemia requiring intubation occurring during the TBIs, and bacterial pneumonia, airway reocclusion, and stent migration occurring after the TBIs, although there was no difference in the frequency of complications during/after the TBIs between the elderly group and nonelderly group (26% vs. 30%, P=0.706). There was no difference in the percentage of patients in whom successful airway recanalization was achieved by TBI (93% vs. 80%, P=0.197), the percentage of patients who showed symptomatic improvement after the TBIs (67% vs. 76%, P=0.380) and the OS after the TBIs (6.1 vs. 7.3 months, P=0.704) between the 2 groups. Conclusions: TBIs can be undertaken without hesitation as a palliative procedure in elderly patients with MCAO.

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Section: Discussioncontrasting

confidence: 42%

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confidence: 99%

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Feasibility, Tolerability, and Effectiveness of Transbronchial Interventions in Elderly Patients With Malignant Central Airway Obstruction

Kashiwabara,

Fujii,

Tsumura

et al. 2024

American Journal of Clinical Oncology

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“…MAO can be due to primary lung malignancy and metastatic lung cancer including endobronchial metastasis. Clinical and technical predictors of success include evidence of patent airway beyond the obstruction, nonsmoking and short area of stent need and a recent CT for planning [4,11]. A recent systematic review included 27 studies.…”

Section: Indications and Patient Selectionmentioning

confidence: 99%

Advancements in airway stents: a comprehensive update

Aravena,

Gildea

2023

Current Opinion in Pulmonary Medicine

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Purpose of review This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It discusses recent advancements, including 3D-printed silicone stents (3DPSS), metallic stents, biodegradable stents (BS), and drug-eluting stents (DES), which are transforming clinical practice. The review underscores the ongoing challenges in patient selection, stent choice, and long-term management in the context of an evolving landscape. Recent findings Innovations, particularly 3DPSS, have shown promise in providing patient-specific solutions. These stents offer improved symptom relief, enhanced quality of life, and lower complication rates, especially for complex airway diseases. The use of BS and DES is explored, raising prospects for future applications. Summary The evolution of AS reflects a deepening understanding of airway obstructions. Recent innovations, such as 3DPSS, BS, and DES, show considerable promise in addressing the limitations of conventional stents. However, challenges related to complications, patient selection, and long-term management persist, demanding further research. Wide practice variations in the management of AS highlight the need for more clinical data and standardized guidelines. The search for the ideal stent continues, driven by the pursuit of better outcomes for patients with CAO.

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“…There is a wide range of survival rates following airway interventions in EC reported in the literature, ranging from 0.8 to 7.1 months (7,(11)(12)(13)(14)(15). There is also limited data on risk factors for TEF formation and survival in EC patients with airway involvement to guide clinical decision making (6,16,17). This study aims to evaluate risk factors for TEF formation and survival in patients with EC who require airway interventions, and proposes an algorithmic management approach based on the findings and a review of literature.…”

Section: Introductionmentioning

confidence: 99%

Airway interventions for tracheobronchial involvement in esophageal carcinoma: a retrospective cohort outcome study and algorithmic approach

Leong¹,

Foo²,

Goh³

et al. 2022

J Thorac Dis

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Background In advanced esophageal carcinoma (EC), there is limited data on risk factors predicting tracheobronchoesophageal fistula (TEF) formation and survival among patients who required airway interventions. Methods A retrospective analysis of consecutive patients with EC, who had airway involvement requiring intervention, was conducted from 1998 to 2018. Demographics, clinical progress, disease stage, treatment and survival outcomes were recorded. Patients were followed up till death or until completion of the study. Survival was estimated with the Kaplan-Meier method and curves compared by log-rank test. Multivariate analyses of risk factors were performed using Cox proportional hazard regression. Results A total of 122 patients were included. The median (IQR) survival from time of airway intervention was 3.30 (1.57–6.88) months, while the median (IQR) survival from time of histological diagnosis was 8.90 (4.91–14.45) months. Tumour location within 20 mm of the carina, prior radiotherapy and/or esophageal stenting were significantly associated with formation of TEF. Mid EC [adjusted hazard ratio (HR) 1.9; 95% confidence interval (CI): 1.1–3.2] or presence of TEF (adjusted HR 1.8; 95% CI: 1.0–3.2) were associated with lower survival. Patients receiving chemotherapy (adjusted HR 0.46; 95% CI: 0.25–0.84), or esophageal stenting whether before or after airway intervention (adjusted HR 0.32; 95% CI: 0.15–0.68 and adjusted HR 0.51; 95% CI: 0.29–0.90) were associated with increased survival. Conclusions Factors associated with TEF formation include airway location, radiotherapy and prior esophageal stenting, and the development of TEF was associated with poorer survival. An algorithmic approach towards tracheobronchial involvement in EC is proposed based on these findings and a review of the literature.

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Predictors of survival and technical success of bronchoscopic interventions in malignant airway obstruction

Cited by 15 publications

References 25 publications

Feasibility, Tolerability, and Effectiveness of Transbronchial Interventions in Elderly Patients With Malignant Central Airway Obstruction

Feasibility, Tolerability, and Effectiveness of Transbronchial Interventions in Elderly Patients With Malignant Central Airway Obstruction

Advancements in airway stents: a comprehensive update

Airway interventions for tracheobronchial involvement in esophageal carcinoma: a retrospective cohort outcome study and algorithmic approach

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