Central airway obstruction develops in a significant proportion of lung cancer patients and many other cancers through metastasis.1 Tumors that cause obstruction of the trachea and the main bronchi are often inoperable.2 Airway stenting is a therapeutic option for malignant central airway obstructions (MCAO) and is indicated for both intraluminal and extraluminal obstructions.3,4 There are several types of stents available and there is a progressive and improved experience of professionals regarding their management.3 Stenting is associated with immediate symptom relief and improved quality of life.5 Palliative and therapeutic benefits are well established, however, complications related to several types of metal and silicone stents are also reported. We report 5 years’ experience with stent placement in patients with MCAO, using rigid bronchoscopy (RB), between January 2015 and December 2019, at Centro Hospitalar Universitário São João.

Fifty-six stents were placed in patients with MCAO, 57.1% for lung cancer, regional extension by other malignancies including esophageal cancer (30.4%), head and neck (3.6%) and lung metastases (3 colorectal, 1 tongue sarcomaand 1 unknown primary). Baseline characteristics of the population and the characteristics of the obstruction observed by bronchoscopy are summarized in Table 1. Most patients had a single lesion, trachea (33.9%), right main bronchus (8.9%), bronchus intermedius (5.4%), left main bronchus (17.9%) and 33.9% of patients had an extended lesion. The severity of airway obstruction was determined using the Myer-Cotton grading system and forty-one patients (73.2%) had ≥ 71% airway lumen obstruction (Grade III or IV). In 10 cases tracheoesophageal fistula was detected.

An equal number of silicone (n=28) and metallic (n=28) stents were placed. In addition to stent insertion, in half of the cases, another bronchoscopy modality was performed, including mechanical dilation, tumor mechanical debulking and laser therapy.

Twenty-one (37.5%) of all stents placed were associated with ≥1 complication, such as mucostasis (in 12 patients, secretions were easily removable by flexible bronchoscopy while in 6 patients RB was needed), migration (n=3), tumor in-growth (n=15), granulation tissue (n=9) and halitosis (n=4) (Table 1). The median time until first complication was 39 (16–96) days.

The occurrence of complications was independent of the type of stent placed (p=0.78), localization of obstruction (p=0.43), type of obstruction (p=0.69), origin of the malignancy (p=0.78), tracheoesophageal fistula (p=0.48) and the extent of the obstruction (p=0.08). However, there was a statistically significant difference between the number of complications and the presence of ≥71% airway lumen obstruction (p<0.05) and in patients with a y-stent (p<0.05).

Overall, the median survival was 68 (32−247) days. The Kaplan-Meier method was used to estimate the overall survival after stent placement in relation to the origin of the neoplasia (pulmonary vs non-pulmonary), type of obstruction and occurrence of complications. According to the analysis (Fig. 1), the median time until death was 145 (70–338) days for patients with stent-related complications and 59 (28–103) days for patients without complications, this difference was the only statistically significant one (p<0.05).

Figure 1.

(A) Box plot demonstrating survival difference (days of survival) in MCAO patients with stent-related complications versus patients without complications. (B) Kaplan–Meier curve for overall survival after stent placement in relation to the occurrence of stent-related complications (black) and the absence of stent-related complications (gray): + indicates censoring cases.

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