Timely Airway Stenting Improves Survival in Patients With Malignant Central Airway Obstruction

Razi, Syed S.; Lebovics, Robert S.; Schwartz, Gary S.; Sancheti, Manu S.; Belsley, Scott; Connery, Cliff P.; Bhora, Faiz Y.

doi:10.1016/j.athoracsur.2010.06.093

Cited by 98 publications

(81 citation statements)

References 28 publications

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“…Metallic stent is effective in reliving symptoms of airway obstruction, facilitating to liberate from ventilator, improving pulmonary function and performance status (50)(51)(52). Compared with poor performance status, patients with malignant central airway obstruction under intermediate performance status have survival benefit after airway stenting (12). This suggests that timely airway stenting before morbid complication is quite important.…”

Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 83%

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Central airway tumors: interventional bronchoscopy in diagnosis and management

Lin

Chung

2016

J. Thorac. Dis.

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The diagnosis of central airway tumors is usually challenging because of the vague presentations.Advances in visualization technology in bronchoscopy aid early detection of bronchial lesion. Cryotechnology has great impact on endobronchial lesion sampling and provides better diagnostic yield. Airway tumor involvements result in significant alteration in life quality and lead to poor life expectancy. Timely and efficiently use ablation techniques by heat or cold energy provide symptoms relief for central airway obstruction. Prostheses implantation is effective in maintaining airway patency after ablative procedure or external compression. Combined interventional bronchoscopy modalities and other adjunctive therapies have improvement in quality of life and further benefit in survival. This review aims to provide a diagnostic approach to central airway tumors and an overview of currently available techniques of interventional bronchoscopy in managing symptomatic central airway obstruction. Here, we provide a clinical review of interventional bronchoscopy in diagnoses and management of central airway tumors. Keywords Diagnostic modalities Computed tomographyOnly less than 30% patients with tracheal tumors have been diagnosed via chest radiography (14). Traditional CT scan is more sensitive and can provide information on the extent of airway lesions. Newly developed multidetector CT (MDCT) can accurately detect airway tumor locations, natures, quantities (1). The extra luminal anatomy is also clearly depicted. Thus, MDCT is a rapid and non-invasive method to provide comprehensive information about the extent of disease process before surgery or interventional bronchoscopy (1). Visualization of bronchoscopyBronchoscopy is the mainstay to approaching endobronchial lesion under direct vision. In addition to conventionally white light bronchoscopy, autofluorescence (AFB) and narrow band imaging (NBI) are new visualization techniques of bronchoscopy which can aid detection of bronchial mucosa lesions (15). Although the specificity of AFB is low and similar to white light bronchoscopy, there is no doubt in usefulness of detecting early bronchial mucosal lesion and evaluate the margin of mucosal involvement (16,17). NBI is designed to detect angiogenesis and neovascular lesion. The diagnostic accuracy is increased under NBI bronchoscopy (15). Both of them have superior sensitivity comparing with white light bronchoscopy [3][4][5]. Endobronchial ultrasonography (EBUS) is also helpful in evaluating the extent of airway lesion involvement (14,18). Tissue sampling: forceps versus cryotechnologyForceps biopsy under direct bronchoscopic vision is the most common method to obtain tissue sample from endobronchial lesion. However, the size of tissue sample is limited by the forceps size. Small samples with crush artifacts are probably insufficient for accurate diagnosis. The diagnostic yield is only 85% of conventional forceps biopsy and patients usually have to repeat bronchoscopy (2,3).Cryotechnology has been used as a t...

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Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 83%

“…The exercise capacity, lung function and quality of life are improved after therapeutic bronchoscopy (11). Moreover, the survival may also been prolonged after airway stenting in selective situation (12,13).…”

Section: Introductionmentioning

confidence: 90%

Central airway tumors: interventional bronchoscopy in diagnosis and management

Lin

Chung

2016

J. Thorac. Dis.

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“…1,2,4,5,16,18,[26][27][28][29][30] We focused solely on patients with malignant central airway obstruction because prior work has shown that the magnitude of the eff ect of risk factors varies based on whether the patient has malignant or benign disease. 1 Many previous studies reporting risk factors for therapeutic bronchoscopy failed to make this distinction.…”

Section: Discussionmentioning

confidence: 99%

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

Ost

Ernst

Grosu

et al. 2015

Chest

149

103

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“…Moreover, airway stenting has consistently improved airflow obstruction parameters on pulmonary function testing (3,(7)(8)(9)(10). Significant improvement in the Eastern Cooperative Oncology Group (ECOG) performance score has also been reported in patients with malignant disease after stent placement (2,11).…”

Section: Introductionmentioning

confidence: 96%

Airway stent complications: the role of follow-up bronchoscopy as a surveillance method

Lee¹,

Labaki²,

Yu³

et al. 2017

J. Thorac. Dis.

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Background: Airway stenting has become an integral part of the therapeutic endoscopic management of obstructive benign and malignant central airway diseases. Despite increased use of airway stents and frequent stent-associated complications, no clear guidelines for surveillance and maintenance exist. This study aim is to elucidate predictive factors associated with development of stent complications, as well as an optimal surveillance period for follow-up bronchoscopy for early detection and possible prevention of stentassociated complications. Compared to all other stents, hybrid stents were more likely to migrate (OR =6.60; 95% CI: 2.16-20.2; P=0.001) or obstruct by secretions (OR =2.53; 95% CI: 1.10-5.84; P=0.03). There were no complications associated with surveillance bronchoscopy.Conclusions: Surveillance bronchoscopy within 4 to 6 weeks of stent placement may be useful for early detection of complications and their subsequent management, regardless of symptomatic status and indication for stent placement. Prospective multicenter studies are needed to compare optimal surveillance methods and the impact on patient mortality, morbidity and healthcare costs.

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Timely Airway Stenting Improves Survival in Patients With Malignant Central Airway Obstruction

Cited by 98 publications

References 28 publications

Central airway tumors: interventional bronchoscopy in diagnosis and management

Central airway tumors: interventional bronchoscopy in diagnosis and management

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

Airway stent complications: the role of follow-up bronchoscopy as a surveillance method

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