The use of stents to restore pulmonary ventilation is the technique of reference in case of carinal obstruction resulting from bronchial tumors invasion or extrinsic compression by mediastinal tumors that most commonly originate from the esophagus. Endoscopic repermeabilization of the carina is technically difficult and the general condition of patients is often poor. The aim of our study is to evaluate the complications and the survival rate of patients treated with self-expanding covered Y stent for large tumors of the carina and to identify the potential predictive factors of postoperative survival rate.
We performed a retrospective monocentric study (2008–2013). All patients underwent chest CT scan before stenting. In all cases, we used an ABS Bolton Ecostent carina Y®. Stenting was done under general anesthesia using the rigid bronchoscope with Jet Ventilation. Stent placement was performed under the control of an X-ray image intensifier. A rigid telescope was also used to confirm the good position of the three segments of the stent.
Thirty-two patients (26 men, mean age=63 years) were included in our study. 20 cases (62.5%) had lung cancer and 12 cases (27.5 %) had esophageal cancer. All tumor types were included. Advanced tumor stage (stage III–IV) was present in 27 patients (87 %). There were no intraoperative or postoperative complications related to stenting (migration, fracture, and granulation). The median survival rate was 49 days (3–673 days). In 82 % of cases, death occurred and was related to disease progression. We found no difference in survival regarding the tumor type and the stage. In a multivariate data analysis, gender, age, body mass index, preoperative and postoperative pulmonary function tests (recorded in 10 patients), and tumor site had no impact on patient survival.
The use of self-expanding covered Y stent in case of carinal obstruction is a reliable technique that can be used in a palliative setting. The poor patients’ survival rate is related to their disease. It is essential to perform a prospective study with preoperative and postoperative pulmonary function tests as well a life quality evaluation, to better target and to optimize the indications for this technique.
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Publié par Elsevier Masson SAS.