Peripheral airways stenting: it is worth the effort? A clinical experience.

Background: At the time of diagnosis or in the follow up, the patients with lung cancer often present locally advanced disease involving peripheral airway. Although they are pauci-symptomatics, they are at risk of disease progression and complication seriously interfering with the administration of additional treatments and worsening of performance status. While the role of endobronchial interventions is clear in the treatment of central airway obstruction, there are few data regarding the feasibility and the efficacy of the stenting in the peripheral airway disorders. Objectives: To report and analyze our experience in the management of airway disorders involving lobar bronchi and secondary carina. Methods: We retrospectively reviewed medical records of patients underwent placement of airway stents due to a stenosis below the main carina at the Interventional Pulmonology Unit, La Maddalena Cancer Center, (Palermo, Italy), between November 2008 and October 2013. Results: Stents were placed in 52 patients with malignant (n=49) and benign airway obstruction (n=1), broncho-esophageal (n=1) and broncho-mediastinal fistula (n=1). Stents were inserted in the left lower lobar bronchus (n=33), in the left upper lobar bronchus (n=1), in the right lower lobar bronchus (n=1) and on the secondary carina at right site (n=15) and at left site (n=2). Both self-expandable metallic stents (n=26) and silicone stents (n=26) were used. All patients were symptomatic with dyspnoea (n=27, 50%) of moderate degree (MMRC 2.4±1.1) and cough (n=22, 41%). Besides one procedural dislocation, the deployment was successful in all patients without procedure related complications with immediate significant improvement of symptoms (MRC p<0,001) and objective radiographic improvement (60%). The mean follow-up duration was 123 days±157. Complications observed were stent migration (9.6%), tumour overgrowth (9.6%), infections (26%), granulation tissue formation (7.6%) and obstruction due to tenacious secretions (1.9%). The overall 3-month and 6-moth survival were 63% and 40%. Factors significantly influencing survival using Kaplan-Meyer long-rank analysis were the availability of post-procedural adjuvant treatment (p<0,0001). Conclusions: The stenting of peripheral airways is technically feasible, effective and acceptable safe. We believe that the proactive stenting in these patients could alter the natural history of the disease and improve survival .