Abstract
BackgroundIn patients with malignant central airway obstruction (MCAO) receiving transbronchial interventions (TBIs), it remains unclear if the prognosis after the intervention might differ according to the bronchoscopic appearance of the airway obstruction. MethodsTBIs were undertaken in MCAO patients with endoluminal obstruction (TM group, n = 19), extraluminal obstruction (EX group, n = 19) and mixed-type obstruction (MX group, n = 23), under moderate sedation and high fractions of inspired oxygen (FiO2). We evaluated the differences in the overall survival period (OS) after the TBIs among the 3 groups. ResultsRegarding the TBIs, the initial procedure was transbronchial microwave ablation (TMA) in the TM group and MX group and stent placement in the EX group. However, 7 patients in the MX group received stent placement as the second-line procedure, after failure of TMA. The OS tended to be longer in the TM/MX group as compared to that in the EX group, both in the subgroups of patients who received post-TBI anticancer therapy (27.2 months/32.9 months vs. 6.0 months, p = 0.011) and in the subgroups of patients who received best supportive care alone (3.2 months/3.1 months vs. 1.4 months, p = 0.072). Multivariate analysis identified adoption of TMA as the initial procedure, successful airway patency restoration following the TBI, and post-TBI anticancer therapy as independent factors associated with a reduced risk of death in patients with MCAO. ConclusionIt is beneficial to administer post-TBI anticancer therapy to MCAO patients with endoluminal or mixed-type obstruction following ablative procedures.
Successful tracheal stent placement for central airway obstruction using dexmedetomidine and regional airway anesthesia
