The use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction

Tracheal neoplasms account for less than 1% of all malignancies. In spite of their low incidence, these tumors represent potentially lethal phenomena. In cases of airway compromise and unresectable disease, the airway may be maintained by repeated bronchoscopic debulkings, and the use of CO(2) laser, silicone Montgomery T-tube and tracheal stents. The use of metallic expandable stents to relieve airway obstruction in advanced tracheal tumors was previously reported. Our aim was to evaluate the use of metallic expandable tracheal stents as a palliative relief from severe airway obstruction in cases of locally advanced, inoperable malignant tracheal tumors. Patients suffering from severe airway obstruction secondary to locally advanced tracheal tumors, who presented to the Otolaryngology Head and Neck Surgery and Chest Diseases Departments at the Main Alexandria University Hospital, Egypt, were included in this study. After endoscopic and radiological evaluation, expandable metallic tracheal stents (SENS; Ultraflex tracheal prosthesis; Boston Scientific Corp, Watertown, MA, USA) were inserted under general anesthesia to relieve airway obstruction. Postoperative follow-up with regard to improvement of respiration, tolerability of the stent and reporting of complications was done. Twelve patients were included, eight males and four females with a mean age of 61 years. Four patients (33.3%) had primary tracheal tumors and eight (66.7%) suffered from tumors infiltrating the trachea from nearby structures. The stent was easily inserted in all patients with no significant intraoperative complications. Postoperatively, the stent was well tolerated and all patients experienced good respiration with significant improvement of respiratory function test results. The most common complication reported was granulation tissue formation. Other complications were displacement of the stent, bad breath, re-growth of tumor tissue at the lower end of the stent and retention of secretions. We concluded that Ultraflex self-expandable stent is a good alternative for palliative relief from airway obstruction in cases of inoperable malignant tracheal tumors. Strict follow-up is mandatory for early detection and management of expected complications.