Background and Study Aims: Locoregional progression
of esophageal cancer can result in respiratory distress aving to tracheoesophageal
(T-E) fistula or central airways stenosis. We report our experience of airway
stenting in 51 patients with esophageal carcinoma involving the central airways.
Patients and Methods: All data were recorded
retrospectively. Fifty-one patients (44 men and seven women), with a mean
age of 58.6 years, were analyzed. All had an esophageal squamous cell carcinoma.
Severe respiratory impairment due to tumor invasion or to a tracheobronchial
fistula (n = 14) was present 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 patients there was a significant improvement
of respiratory symptoms. Esophageal 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 days. There was no difference between mean survival
in the patients with fistulae (103.3 ± days) and the
others (109.3 ± days). In two cases stent placement 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 airways was noted from one to 11 months after stenting,
inducing a relapse of dyspnea.
Conclusions: Complications are easily detected
by the appearance of respiratory symptoms and do not necessitate systematic
flexible bronchoscopy, but only preventive measures such as regular aerosol
therapy, adapted respiratory physiotherapy and regular clinical follow-up.
