Malignant Airway Obstruction and Endobronchial Stent Placement: A Systematic Review on the Efficacy and Safety

The systematic review aims to evaluate the efficacy and safety of endobronchial stent placement for malignant airway obstruction. A comprehensive search was conducted across multiple databases to identify relevant studies. Cohort studies, randomized controlled trials, and case-control studies examining the outcomes of endobronchial stent placement in patients with malignant airway obstruction were included. Data on pre-treatment evaluation, such as pulmonary function testing, dyspnea severity scoring systems, arterial blood gas parameters, imaging, and degree of obstruction, were also collected. Primary outcomes of interest included post-procedure stenosis, pulmonary function testing evaluation, blood gas parameters, and survival outcomes. Secondary outcomes encompassed improvements in clinical status, dyspnea grade, and procedure-related complications. A total of 27 studies met the inclusion criteria and were included in the systematic review. The included studies demonstrated promising outcomes of endobronchial stent placement in managing malignant airway obstruction. Post-procedure airway diameters, pulmonary function testing, and blood gas parameters improved significantly. Survival outcomes varied among studies. Furthermore, endobronchial stent placement was associated with improvements in clinical status and dyspnea grade. Procedure-related complications ranged from pain, hemoptysis and mucus plugging to stent obstruction, migration and pneumothorax. This systematic review suggests that endobronchial stent placement is an effective and safe intervention for managing malignant airway obstruction. It offers significant improvements in post-procedure stenosis, pulmonary function testing, blood gas parameters, and clinical outcomes. However, further studies with larger sample sizes and standardized reporting are warranted to better evaluate the long-term efficacy and safety of endobronchial stent placement for malignant airway obstruction.

[1]  Wei Huang,et al.  Preliminary Experience With a Novel Metallic Segmented Transcordal Stent Modified With Three-Dimensional Printing for Inoperable Malignant Laryngotracheal Stenosis , 2021, Frontiers in Oncology.

[2]  A. Iyoda,et al.  Long-term survival of airway silicone stents in patients with central airway stenosis or obstruction due to thoracic malignancy , 2021, General Thoracic and Cardiovascular Surgery.

[3]  E. Clini,et al.  Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE). , 2020, Lung cancer.

[4]  U. Khalid,et al.  Indications and clinical outcomes of fully covered self-expandable metallic tracheobronchial stents in patients with malignant airway diseases , 2020, Expert review of respiratory medicine.

[5]  L. Thiberville,et al.  Self-expanding metallic Y-stent compared to silicone Y-stent for malignant lesions of the main carina: A single center retrospective study. , 2020, Respiratory medicine and research.

[6]  V. Palumbo,et al.  Secondary Carina and Lobar Bronchi Stenting in Patients with Advanced Lung Cancer: Is It Worth the Effort? A Clinical Experience , 2020, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[7]  J. Vergnon,et al.  Impact of Silicone Stent Placement in Symptomatic Airway Obstruction due to Non-Small Cell Lung Cancer – A French Multicenter Randomized Controlled Study: The SPOC Trial , 2020, Respiration.

[8]  Ihab Eldessouki,et al.  Stenting in Non-Small Cell Lung Cancer: How Does It Affect the Outcomes? , 2020, Asian Pacific Journal of Cancer Prevention.

[9]  S. Goh,et al.  Outcome differences between recanalized malignant central airway obstruction from endoluminal disease versus extrinsic compression , 2018, Lasers in Medical Science.

[10]  Jian Hu,et al.  Clinical assessment of airway stent placement in patients with malignant airway lesions. , 2018, Journal of thoracic disease.

[11]  M. Oki,et al.  Airway stenting in patients requiring intubation due to malignant airway stenosis: a 10-year experience. , 2017, Journal of thoracic disease.

[12]  A. Charlett,et al.  Study quality assessment tools , 2016 .

[13]  L. Dalar,et al.  Therapeutic bronchoscopic interventions for malignant airway obstruction , 2016, Medicine.

[14]  F. Herth,et al.  Airway stent: what is new and what should be discarded , 2016, Current opinion in pulmonary medicine.

[15]  L. Dalar,et al.  Placement of self-expandable bifurcated metallic stents without use of fluoroscopic and guidewire guidance to palliate central airway lesions , 2016, Multidisciplinary Respiratory Medicine.

[16]  C. Crimi,et al.  Fully Covered Self-Expandable Metal Stent in Tracheobronchial Disorders: Clinical Experience , 2015, Respiration.

[17]  H. Grosu,et al.  Stents are associated with increased risk of respiratory infections in patients undergoing airway interventions for malignant airways disease. , 2013, Chest.

[18]  J. Usuda,et al.  Outcomes of airway stenting for advanced lung cancer with central airway obstruction. , 2010, Interactive cardiovascular and thoracic surgery.

[19]  F. Bhora,et al.  Timely airway stenting improves survival in patients with malignant central airway obstruction. , 2010, The Annals of thoracic surgery.

[20]  H. Marres,et al.  Clinical aspects and treatment of primary tracheal malignancies , 2010, Acta oto-laryngologica.

[21]  M. Tamm,et al.  Therapeutic bronchoscopy for malignant airway stenoses: choice of modality and survival. , 2010, Journal of cancer research and therapeutics.

[22]  G. Ferretti,et al.  Computed Tomography Measurements for Airway Stent Insertion in Malignant Airway Obstruction , 2010, Journal of bronchology & interventional pulmonology.

[23]  A. Ernst,et al.  Endoscopic management of central airway obstruction. , 2009, Seminars in thoracic and cardiovascular surgery.

[24]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[25]  M. Kramer,et al.  Endobronchial stent for malignant airway obstructions. , 2006, The Israel Medical Association journal : IMAJ.

[26]  T. Miyazawa,et al.  Stenting at the flow-limiting segment in tracheobronchial stenosis due to lung cancer. , 2004, American journal of respiratory and critical care medicine.

[27]  R. Landreneau,et al.  Bronchoscopic palliation of primary lung cancer: Single or multimodality therapy? , 2004, Surgical Endoscopy.

[28]  F. Stanzel,et al.  Use of Studded Polyflex™ Stents in Patients with Neoplastic Obstructions of the Central Airways , 2004, Respiration.

[29]  Atul C Mehta,et al.  Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. , 2003, Chest.

[30]  K. Furukawa,et al.  Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses. , 2000, Chest.

[31]  Y. Nakajima,et al.  Efficacy and complications of the gianturco-Z tracheobronchial stent for malignant airway stenosis , 1999, CardioVascular and Interventional Radiology.

[32]  J. Zwischenberger,et al.  Airway simulation to guide stent placement for tracheobronchial obstruction in lung cancer. , 1997, The Annals of thoracic surgery.

[33]  K. Shirouzu,et al.  Experience of expandable metallic stents for central airway obstruction. , 1997, Japanese journal of clinical oncology.

[34]  F. Venuta,et al.  Endoscopic treatment of malignant airway obstructions in 2,008 patients. , 1996, Chest.

[35]  K. Haeussinger,et al.  The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers. A prospective, multicenter study. , 1996, Chest.

[36]  H. Fujita,et al.  Expandable metallic stents for tracheobronchial stenoses in esophageal cancer. , 1996, The Annals of thoracic surgery.

[37]  M. Walshaw,et al.  Treatment of large airway obstruction in lung cancer using expandable metal stents inserted under direct vision via the fibreoptic bronchoscope. , 1996, Thorax.

[38]  K Tschopp,et al.  Silicone stents in the management of inoperable tracheobronchial stenoses. Indications and limitations. , 1993, Chest.

[39]  S. Morinaga,et al.  Indications for an expandable metallic stent for tracheobronchial stenosis. , 1993, The Annals of thoracic surgery.

[40]  H. Nakamura,et al.  Endotracheal Expandable Metallic Stent Placement in Dogs , 1991, Acta radiologica.

[41]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[42]  N. Lou,et al.  [Tracheal stent implantation for the treatment of tumor-induced acute airway stenosis]. , 2008, Ai zheng = Aizheng = Chinese journal of cancer.