EMERGENCY STENTING OF MALIGNANT OBSTRUCTION OF THE UPPER AIRWAYS - LONG-TERM FOLLOW-UP WITH 2 TYPES OF SILICONE PROSTHESES

Objective: We evaluated the long-term prognosis of stents placed on an emergency basis in the trachea and its bifurcation for malignant sten osis, Methods:We retrospectively analyzed all bronchologic treatments of obstructing airway lesions from January 1993 to December 1995. Resu lts: We report on 10 patients with severe malignant ''mixed-type'' obs truction of the proximal trachea or distal trachea plus both main-stem bronchi, They had far-advanced inoperable tumor (esophageal cancer, n = 4; lung cancer: n = 3; recurrent laryngeal uvula, and thyroid cance r: n = 1 each), Emergency treatment consisted of a dilating bougie man euver followed by the insertion of a large one-way (n = 4) or Y-shaped silicone prosthesis (n = 6), After the intervention, there was a long -lasting clinical improvement. Median survival from stent insertion wa s 8 months for all patients irrespective of tumor type; it was 5 month s for patients with lung carcinoma and 8 months for those with esophag eal cancer, The results are in accordance with other studies using dif ferent therapeutic modalities, Stent exchange was necessary in five pa tients, Main reasons were continuing tumor growth beyond the proximal and distal boundaries and recurrent productive bronchial infection, Pa tients died of pneumonia (n = 4), pulmonary lymphatic spread (n = 1), cardiac failure (n = 2), and fatal hemorrhage (n = 1), As of December 1995, three patients were still alive 2, 5, and 8 months after implant ation, Conclusions: As evidenced by clinical efficiency and length of palliation, endoscopic placement of silicone-based one-way and bifurca tional prostheses in far-advanced tumor of the central airways is tech nically feasible and ethically justifiable.