THE USE OF THE COVERED WALLSTENT FOR THE PALLIATIVE TREATMENT OF INOPERABLE TRACHEOBRONCHIAL CANCERS - A PROSPECTIVE, MULTICENTER STUDY

Study objective: To investigate the safety, efficacy, and tolerance of the covered Wallstent for the palliative treatment of inoperable trac heobronchial cancer. Design: An 8-month prospective study employing ei ther a rigid bronschoscope or a flexible delivery system for prosthesi s insertion. Setting: Multicentric setting involving four teaching hos pitals in Switzerland and Germany. Patients: Forty patients (29 men, 1 1 women), average age of 62 years, presenting with an inoperable trach eobronchial cancer. Interventions: After partial airway recanalization with an Nd-YAG laser, the covered Wallstent was inserted 23 times usi ng a rigid bronchoscope (Rigidstep device), and 27 times using a flexi ble delivery system (Telestep device) under fluoroscopic and endoscopi c visualization. Results: Clinical and endoscopic examination at 1, 30 , and 90 days showed improvement in the bronchial lumen and in the dys pnea index. No serious complication (death, perforation, hemorrhage, i nability to remove an improperly placed prosthesis) was observed durin g surgery. Late complications included migration (12%), inflammatory g ranulations or tumor regrowth at the tip of the prosthesis (36%), and symptomatic retention of secretion (38%). Conclusions: Compared with o ther tracheobronchial prostheses, notably the Dumon stent, the covered Wallstent presents the following advantages: insertion with visual gu idance, treatment of extrinsic compressions and esophagobronchial fist ulas, and little chance of migration when the prosthesis diameter is c hosen correctly. The following disadvantages can be noted: high price; both repositioning and extraction of the released stent are more diff icult, though certainly possible; and risk of granulations at the tips of the prosthesis and retention of secretions. Suggestions are made f or potential improvements to the stent and insertion system that may r esult in a significant decrease in early and late complications.