Original article
General thoracic
Decannulation in Tracheal Stenosis Deemed Inoperable Is Possible After Long-Term Airway Stenting

https://doi.org/10.1016/j.athoracsur.2012.09.037Get rights and content

Background

Decannulation is the ultimate therapeutic goal for patients who undergo stenting because of inoperable benign tracheal stenosis. In this study, our objectives were to evaluate whether long-term airway stenting allows decannulation in patients with benign tracheal stenosis who were deemed inoperable and to identify possible predictive factors for successful decannulation (SD).

Methods

Retrospective cohort study including all patients with inoperable benign tracheal stenosis who underwent tracheal stenting in our tertiary-care university-based institution from 1998 to 2008. For benign stenosis, we use only silicone stents (T tubes, Dumon stents, and Y stents). The main outcome was SD, which was defined as removal of the tracheal stent followed by absence of respiratory symptoms and no requirement for new dilation procedures for at least 6 months. A Kaplan-Meier curve was built to evaluate SD in 5 years, and we used a Cox model to evaluate predictors for a SD.

Results

Ninety-two patients were included, and during the study period 21 were decannulated. However, 2 of them had to undergo new airway procedures and were considered to represent failure. Therefore, 19 patients were successfully decannulated. According to the Kaplan-Meier estimate, the SD rate in 5 years was 27.5%. The mean follow-up time after SD was 34.3 ± 33.9 months (range, 6 to 108 months). Cox regression showed only 1 significant factor: tracheostomy before stent insertion caused a threefold increase in the likelihood of the patient remaining with a tracheal stent (p = 0.048).

Conclusions

Tracheal stenting may be considered a curative therapeutic approach in as many as 27.5% of patients with inoperable benign tracheal stenosis.

Section snippets

Patients and Methods

This was a retrospective cohort study conducted at an academic reference center for tracheal diseases with an outpatient clinic performing between 30 and 40 consultations per week. All patients who received silicone tracheal stents in our institution from January 1998 to December 2008 were included. This cohort included only patients with benign tracheal stenosis who were treated with tracheal stents exclusively; patients with neoplastic invasion of the trachea, stenting before airway

Results

Two hundred six patients were treated with silicone tracheal stents during the study period. All patients undergoing stenting were followed up at the tracheal surgery outpatient clinic. The flowchart of the study is shown in Figure 2. Ninety-two individuals were included in the study, and the patients' demographics are given in Table 1.

Patients were considered inoperable because of long segment tracheal stenosis in 38 patients (41%), high surgical risk in 42 (46%), and 12 (13%) who had to

Comment

In the present study we observed that long-term airway stenting allowed successful decannulation in 27.5% of the patients considered not eligible for tracheal resection over a 60-month period. Tracheostomy was the sole significant factor for decannulation and led to a threefold increase in the likelihood of a patient's remaining with a tracheal stent.

Cure of benign tracheal stenosis after long-term airway stenting is controversial but has been cited in pivotal articles. In a report by Cooper

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