Surgery Today

, Volume 40, Issue 4, pp 315–320

The role of airway stent placement in the management of tracheobronchial stenosis caused by inoperable advanced lung cancer

  • Kinya Furukawa
  • Junzo Ishida
  • Gaku Yamaguchi
  • Jitsuo Usuda
  • Hidemitsu Tsutsui
  • Makoto Saito
  • Chimori Konaka
  • Harubumi Kato
Original Article

Abstract

Purpose

To our knowledge there is no in-depth report on the benefits of airway stenting, which focuses specifically on patients with inoperable advanced lung cancer causing severe central airway obstruction. We evaluated the role of airway stenting as one aspect of the multidisciplinary management of advanced lung cancer.

Methods

We performed airway stenting in 40 lung cancer patients, placing a total of 58 stents. Stenting was done as a final modality in 22 patients with terminal-stage lung cancer (group A). The other 18 patients received additional therapy after stenting (group B), 12 (66.7%) of whom were treatment-naïve on admission.

Results

The performance status (PS) and Hugh-Jones classification (H-J) scores improved in both groups after stenting: from 3.56 to 2.48 (P = 0.001) and 4.29 to 3.20 (P = 0.004) in group A, and from 3.15 to 1.25 (P < 0.001) and 4.10 to 2.10 (P < 0.001) in group B, respectively. The median survival time and 1-year survival rate after stenting were 1.6 months and 5.1%, respectively, in group A, and 5.6 months and 25.0%, respectively, in group B.

Conclusions

Airway stenting followed by adjuvant therapy may improve the survival of treatment-naïve patients with severe symptomatic airway obstruction caused by advanced lung cancer.

Key words

Lung cancer Airway stenosis Airway stenting Tracheobronchial stent Adjuvant therapy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710–1717.CrossRefPubMedGoogle Scholar
  2. 2.
    Mitchell JD, Mathisen DJ, Wright CD, Wain JC, Donahue DM, Allan JS, et al. Resection for bronchogenic carcinoma involving the carina: long-term results and effect of nodal status on outcome. J Thorac Cardiovasc Surg 2001;121:465–471.CrossRefPubMedGoogle Scholar
  3. 3.
    Cavaliere S, Venuta F, Foccoli P, Toninelli C, La Face B. Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest 1996;110:1536–1542.CrossRefPubMedGoogle Scholar
  4. 4.
    Mantovani G, Astara G, Manca G, Versace R, Contu P, Carai A. Endoscopic laser ablation as palliative treatment of endobronchial, nonresectable, or recurrent lung cancer: assessment of its impact on quality of life. Clin Lung Cancer 2000;1:277–285.CrossRefPubMedGoogle Scholar
  5. 5.
    Diaz-Jimenez JP, Martinez-Ballarin JE, Llunell A, Farrero E, Rodriguez A, Castro MJ. Efficacy and safety of photodynamic therapy versus Nd-YAG laser resection in NSCLC with airway obstruction. Eur Respir J 1999;14:800–805.CrossRefPubMedGoogle Scholar
  6. 6.
    Loewen GM, Pandey R, Bellnier D, Henderson B, Dougherty T. Endobronchial photodynamic therapy for lung cancer. Lasers Surg Med 2006;38:364–370.CrossRefPubMedGoogle Scholar
  7. 7.
    Freitag L, Ernst A, Thomas M, Prenzel R, Wahlers B, Macha HN. Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma. Thorax 2004;59:790–793.CrossRefPubMedGoogle Scholar
  8. 8.
    Santos RS, Raftopoulos Y, Keenan RJ, Halal A, Maley RH, Landreneau RJ. Bronchoscopic palliation of primary lung cancer: single or multimodality therapy? Surg Endosc 2004;18:931–936.CrossRefPubMedGoogle Scholar
  9. 9.
    Dumon JF. A dedicated tracheobronchial stent. Chest 1990;97:328–332.CrossRefPubMedGoogle Scholar
  10. 10.
    Mehta AC, Dasgupta A. Airway stents. Clin Chest Med 1999;20:139–151.CrossRefPubMedGoogle Scholar
  11. 11.
    Becker HD. Stenting of central airways. J Bronchology 1995;2:98–106.CrossRefGoogle Scholar
  12. 12.
    Colt HG, Harrell JH. Therapeutic rigid bronchoscopy allows level of care changes in patients with acute respiratory failure from central airway obstruction. Chest 1997;112:202–206.CrossRefPubMedGoogle Scholar
  13. 13.
    Nakajima Y, Kurihara Y, Niimi H, Konno S, Ishikawa T, Osada H, et al. Efficacy and complications of the Gianturco-Z tracheobronchial stent for malignant airway stenosis. Cardiovasc Intervent Radiol 1999;22:287–292.CrossRefPubMedGoogle Scholar
  14. 14.
    Miyazawa T, Yamakido M, Ikeda S, Furukawa K, Takiguchi Y, Tada H, et al. Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest 2000;118:959–965.CrossRefPubMedGoogle Scholar
  15. 15.
    Freitag L, Eicker R, Linz B, Greschuchna D. Theoretical and experimental basis for the development of a dynamic airway stent. Eur Respir J 1994;7:2038–2045.PubMedGoogle Scholar
  16. 16.
    Bolliger C, Probst R, Tschopp K, Soler M, Perruchoud AP. Silicone stents in the management of inoperable tracheobronchial stenosis. Indications and limitations. Chest 1993;104:1653–1659.CrossRefPubMedGoogle Scholar
  17. 17.
    Monnier P, Mudry A, Stanzel F, Haeussinger K, Heitz M, Probst R, et al. The use of the covered wallstent for the palliative treatment of inoperable tracheobronchial cancers. Chest 1996;110:1161–1168.CrossRefPubMedGoogle Scholar
  18. 18.
    Petersen BD, Uchida BT, Barton RE, Keller FS, Rosch J. Gianturco-Rosch Z stents in tracheobronchial stenoses. J Vasc Interv Radiol 1995;6:925–931.CrossRefPubMedGoogle Scholar
  19. 19.
    Saad CP, Murthy S, Krizmanich G, Mehta AC. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest 2003;124:1993–1999.CrossRefPubMedGoogle Scholar
  20. 20.
    Martinez-Ballarin JI, Diaz-Jimenez JP, Castro MJ, Moya JA. Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients. Chest 1996;109:626–629.CrossRefPubMedGoogle Scholar
  21. 21.
    Bolliger CT, Heitz M, Hauser R, Probst R, Perruchoud AP. An airway wall-stent for the treatment of tracheobronchial malignancies. Thorax 1996;51:1127–1129.CrossRefPubMedGoogle Scholar
  22. 22.
    Saito Y, Imamura H. Airway stenting. Surg Today 2005;35:265–270.CrossRefPubMedGoogle Scholar
  23. 23.
    Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 1996;32A:1135–1141.CrossRefPubMedGoogle Scholar
  24. 24.
    Langer C, Lilenbaum R. Role of chemotherapy in patients with poor performance status and advanced non-small cell lung cancer. Semin Oncol 2004;31:8–15.CrossRefPubMedGoogle Scholar
  25. 25.
    Kosmidis P, Mylonakis N, Nicolaides C, Kalophonos C, Samantas E, Boukovinas J, et al. Paclitaxel plus carboplatin versus gemcitabine plus paclitaxel in advanced non-small-cell lung cancer: a phase III randomized trial. J Clin Oncol 2002;20:3578–3885.CrossRefPubMedGoogle Scholar
  26. 26.
    Lilenbaum RC, Herndon JE 2nd, List MA, Desch C, Watson DM, Miller AA, et al. Single-agent versus combination chemotherapy in advanced non-small-cell lung cancer: the cancer and leukemia group B (study 9730). J Clin Oncol 2005;23:190–196.CrossRefPubMedGoogle Scholar
  27. 27.
    Sweeney CJ, Zhu J, Sandler AB, Schiller J, Belani CP, Langer C, et al. Outcome of patients with a performance status of 2 in Eastern Cooperative Oncology Group Study E1594: a Phase II trial in patients with metastatic nonsmall cell lung carcinoma. Cancer 2001;92:2639–2647.CrossRefPubMedGoogle Scholar
  28. 28.
    Alberola V, Camps C, Provencio M, Isla D, Rosell R, Vadell C, et al. Cisplatin plus gemcitabine versus a cisplatin-based triplet versus nonplatinum sequential doublets in advanced non-small-cell lung cancer: a Spanish Lung Cancer Group phase III randomized trial. J Clin Oncol 2003;21:3207–3213.CrossRefPubMedGoogle Scholar
  29. 29.
    Lemaire A, Burfeind WR, Toloza E, Balderson S, Petersen RP, Harpole DH Jr, et al. Outcomes of tracheobronchial stents in patients with malignant airway disease. Ann Thorac Surg 2005;80:434–437.CrossRefPubMedGoogle Scholar
  30. 30.
    Chhajed PN, Baty F, Pless M, Somandin S, Tamm M, Brutsche MH. Outcome of treated advanced non-small cell lung cancer with and without central airway obstruction. Chest 2006;130:1803–1807.CrossRefPubMedGoogle Scholar
  31. 31.
    Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Tracheobronchial stenting in the terminal care of cancer patients with central airways obstruction. Chest 2001;120:1811–1814.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Kinya Furukawa
    • 1
  • Junzo Ishida
    • 1
  • Gaku Yamaguchi
    • 1
  • Jitsuo Usuda
    • 2
  • Hidemitsu Tsutsui
    • 2
  • Makoto Saito
    • 1
  • Chimori Konaka
    • 2
  • Harubumi Kato
    • 2
  1. 1.Department of Thoracic SurgeryTokyo Medical University, Kasumigaura HospitalIbarakiJapan
  2. 2.Department of Thoracic SurgeryTokyo Medical UniversityTokyoJapan

Personalised recommendations