Rigid bronchoscopy and stenting for esophageal cancer causing airway obstruction

Background: Thirty percent of patients with esophageal cancer have malignant involvement of the major airways, leading to respiratory distress and life-threatening major airway obstruction. Tracheobronchial stenting has been reported to be effective in providing sustained relief from obstruction. Methods: We conducted a chart review of all patients with advanced inoperable esophageal cancer who had malignant tracheobronchial obstruction requiring rigid bronchoscopy and airway stenting at our institution between June 1998 and July 2001. Outcome measures, which included survival, efficacy, and complications, were recorded. Results: There were 11 patients (4 women) with a mean age of 61 years. Five patients had distant metastases at the time they underwent rigid bronchoscopy. Four patients who required mechanical ventilation for respiratory failure were successfully weaned off mechanical ventilation after the stenting procedure. All patients with dyspnea had immediate relief of respiratory symptoms, which was sustained for seven patients (64%). The mean duration of survival was 61 days. Two patients required repeat procedures, one for stent dislodgment on extubation and the other for stent migration. Conclusion: Stenting in patients with malignant tracheobronchial obstructions due to advanced esophageal cancer achieves immediate, dramatic, and sustainable relief in respiratory symptoms, conferring a survival benefit in patients whose conditions are otherwise deemed to be terminal.