Original article
General thoracic
Long-Term Follow-Up of Ultraflex Metallic Stents in Benign and Malignant Central Airway Obstruction

https://doi.org/10.1016/j.athoracsur.2006.11.066Get rights and content

Background

We report experience with Ultraflex metallic stents (Boston Scientific, Natick, MA) inserted at rigid bronchoscopy under general anesthesia for palliation of benign and malignant upper airway obstruction.

Methods

Notes of all patients treated with Ultraflex stents from 1999 to 2003 were reviewed for symptomatic response, spirometric data, and any complications before discharge home. Long-term outcome was assessed by questionnaires sent to patients’ general practitioners.

Results

Recruited were 66 patients (12 benign, 54 malignant airway obstructions). Before discharge home, breathlessness improved in 11 of 12 patients with benign obstruction and in 39 of 54 with malignancies. Postoperative complications in 10 patients with malignant obstructions and in 2 patients with benign obstruction were successfully controlled. It was not possible to perform preoperative pulmonary function tests in most of the patients who presented as emergencies. Mean improvement in forced expiratory volume in 1 second was 0.88 liters in 3 patients with benign obstruction and 0.28 liters in 14 patients with malignant obstruction, and mean peak expiratory flow rate improved by 109 L/min and 97 L/min, respectively. General practitioners completed questionnaires for 12 benign patients and 46 of 54 patients with malignancies. At a mean follow-up of 1017 days (range, 46 to 1120 days), 10 of the 12 patients with benign disease were alive and 7 of 46 patients with malignant airway obstruction were alive, with a median survival of 128 days (mean, 361; range, 3 to 1859 days). Most survivors had Medical Research Council grade III breathlessness or better, with few stent-related symptoms.

Conclusions

Ultraflex stents proved safe and effective in prolonged palliation of benign and malignant airways obstruction.

Section snippets

Patients and Methods

This was a retrospective observational study. Methodology and patient confidentiality was approved by the Audit Committee of United Bristol Healthcare Trust (our Institutional Review Board for Audit Projects). The Research Ethics Committee was also asked to review the design of the project and further confirmed that it constituted an audit, which did not require patient consent. By searching for the surgical procedure code for endobronchial stenting, we identified all patients who had been

Results

Procedure codes were used to identify 100 patients who had been treated with a stent in the period 1999 to 2003. Of these, 66 patients had been treated with one or more Ultraflex stents and were further studied. Their mean age was 64 years (range, 22 to 87 years). Malignant airway obstruction was present in 54 patients: 39 had primary carcinomas of the trachea or main bronchi, and 15 had primary tumors in other organs that had invaded or compressed the central airways or metastasized to them.

Comment

Surgery is the best treatment for benign and malignant airways obstruction, but is only possible in a few patients because of the extent of malignant disease or other medical conditions that render patients unfit for surgery. In the case of benign tracheal strictures, surgical resection and anastomosis is the ideal treatment, but even in patients otherwise fit for surgery, only some 50% of the tracheas can be resected. No satisfactory prosthesis has yet been developed that permits more

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