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

We report on 10 patients with severe malignant ''mixed-type'' obstruct ion of the proximal trachea or distal trachea plus both main stem bron chi. They had far-advanced inoperable tumors (esophageal cancer in 4 p atients, lung cancer in 3, and recurrent laryngeal, uvular, and thyroi d cancers in 1 each). Emergency treatment consisted of a dilating boug ie maneuver followed by the insertion of a large one-way (4 patients) or Y-shaped (6) silicone prosthesis. Subsequent to the intervention, t here was long-lasting clinical improvement. The median survival from s tent insertion was 8 months for all patients irrespective of tumor typ e; it was 5 months for lung carcinoma patients and 8 months for those with esophageal cancer. The results are in accordance with those of ot her studies using different therapeutic modalities. Stent exchange pro ved necessary in 5 patients. The main reasons were continuing tumor gr owth beyond the proximal and distal boundaries and recurrent productiv e bronchial infection. Patients died of pneumonia (4 patients), pulmon ary lymphangitic spread (1), heart failure (2, one of whom also had pn eumonia), and fatal hemorrhage (1). As of December 1995, 3 patients we re still alive, 2, 5, and 8 months after stent implantation. As eviden ced by clinical efficacy and length of palliation, endoscopic placemen t of silicone-based one-way and bifurcated prostheses in far-advanced tumor of the central airways is technically feasible and ethically jus tifiable.