Tracheobronchial stenting in patients with esophageal cancer involving thecentral airways

Background and Study Aims: Locoregional progression of esophageal cancer ca n result in respiratory distress aving to tracheoesophageal (T-E) fistula o r central airways stenosis, We report our experience of airway stenting in 51 patients,vith esophageal carcinoma involving the central airways. Patients and Methods: All data were recorded retrospectively. Fifty-one pat ients (44 men and seven women), with a mean age of 58.6 years, were analyze d. All had an esophageal squamous cell carcinoma. Severe respiratory impair ment due to tumor invasion or to a tracheobronchial fistula (n = 14) was pr esent in all patients. Nine of the 14 patients with fistula had dysphagia, Among the 37 patients without fistula, 19 had dysphagia, Results: Sixty-six tracheobronchial stents were inserted in 51 patients: 65 Dumon stents and one Wallstent. Forty stents were implanted in the trachea , 16 in the left main bronchus and 10 in the right main bronchus, In 47 pat ients there was a significant improvement of respiratory symptoms. Esophage al intubation, carried out in nine patients, allowed eating and drinking in all cases. Mean survival was 107.7 days, with the longest follow-up 587 da ys, There was no difference between mean survival in the patients with fist ulae (103.3 +/- days) and the others (109.3 +/- days). In two cases stent p lacement was responsible for death (massive hemoptysis and pneumonia), The main complications were migration (n = 6), granuloma (n = 2), pneumonia (n = 2) and pneumothorax (n = 2), In 13 patients tumor progression in the airw ays was noted from one to 11 months after stenting, inducing a relapse of d yspnea, Conclusions: Complications are easily detected by the appearance of respira tory symptoms and do not necessitate systematic flexible bronchoscopy, but only preventive measures such as regular aerosol therapy, adapted respirato ry physiotherapy and regular clinical followup.