Page 40 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED e-POSTER SESSION 01:
Central Airway management
SURVIVAL ANALYSIS AFTER BRONCHOSCOPIC INTERVENTION FOR MALIGNANT AIRWAY OBSTRUCTION
Claudia Freitas1,2, Mariana Serino1, Helder Novais-Bastos1,2, António Morais1,2, Adriana Magalhães1, Gabriela Fernandes1
1 Centro Hospitalar e Universitário De São João, Porto, Portugal 2 Faculty of Medicine, University of Porto, Porto, Portugal
PP01
Introduction: Malignant airway obstruction (MAO) is a potential life-threatening complication of cancer. Interventional bronchoscopy permit to restore airway patency, leading to a better quality of life and survival.
Aim: Determine survival among MAO patients who underwent bronchoscopic intervention and explore prognostic factors. Methods: Consecutive patients diagnosed with MAO were prospectively enrolled. Survival was estimated by Kaplan-Meyer
method and curves compared with log rank test.
Results: 61 patients were included, 70.5% (n=43) were males with a median 61 years-old (range, 21 - 89). Majority were ECOG 0-1 (81.9%, n=50). Concerning the primary malignancy, 75.4% (n=46) were due to lung cancer and 24.6% (n=15) to extrapulmonary malignancy, including oesophagus (9.8%; n=6), colorectal (8.2%; n=5), breast (1.6%; n=1), thyroid (1.6%; n=1), liver (1.6%; n=1), head and neck (1.6%; n=1); majority had stage IV disease (50.8%; n=31). Regarding MAO classification, 62.3% (n=38) were endobronchial, 3.3% (n=2) caused by extrinsic compression and 34.4% (n=21) were mixed; the majority were Meyer Cotton grade III (37.6%; n=23) or IV (54.1%, n=33) with a median of 30 millimetres of extension (range, 5 - 65). 54.1% (n=33) were single lesions located in main stem bronchus (24.6%, n=15), trachea (9.8%, n=6), bronchus intermedius (9.8%, n=6) and lobar bronchus (9.8%, n=6); while 45.9% (n=28) were extended lesions affecting ≥2 bronchi or bronchi and trachea. 6.6% (n=4) had combined tracheoesophageal fistula. A median of 2 bronchoscopies (range, 1 - 10) and 1 interventions (range, 1 - 7) were performed, including: mechanical debulking (82.0%, n=50), laser (68.9%, n=42), mechanical dilation either with rigid bronchoscope (21.3%, n=13) or balloon (3.3%, n=2), silicone (18.0%, n=11) or self-expandable metallic stent (13.1%, n=8). Technical success (residual obstruction<50% and distal airway patency) was achieved in 82.0% (n=50). Procedure and stent-related complications occurred in 34.4% (n=21) and 47.4% (n=9), respectively, mostly mild. Systemic treatment was performed in 62.3% (n=38) patients, radiotherapy in 26.2% (n=16) and surgery in 8.2% (n=5). Median overall survival since bronchoscopic intervention was 8 months (mo) (95% CI, 2.7-13.3). Pure endobronchial lesion (13 mo, 95% CI 9.9-16.1 vs mixed/extrinsic compression: 1mo, 95% CI, 0-2.3; p<0.01) and successful intervention (9 mo, 95% CI 5.2-12.8 vs 1mo, 95% CI 0-3.2; p=0.06) tended to associated with improved survival.
Conclusion: Interventional bronchoscopy is a safe and effective procedure for MAO patients, contributing to survival improvement.
PP02
Introduction: Central airway obstruction develops in a significant proportion of lung cancer patients and in many other cancers through metastasis. Airway stenting is a therapeutic option for malignant central airway obstructions (MCAO). Palliative and therapeutic benefits of stenting are well established, but complications are not uncommon.
Methods: Retrospective cohort study of stents placed in patients with MCAO, using rigid bronchoscopy (RB), at our institution, between January 2015 and December 2019. Stent-related complications and survival were analyzed.
Results: Sixty-three airway stents were placed in 56 patients with MCAO, 80.4% were males and mean age was 59.5±12 years. The origin of MCAO was lung (57.1%), regional extension by esophageal (30.4%) or head and neck (3.6%) cancer and metastases (3 colorectal, 1 tongue sarcoma and 1 unknown primary). Most patients had a single lesion, trachea (33.9%), right main bronchus (8.9%), right bronchus intermedius (5.4%), left main bronchus (17.9%) and 33.9% of patients had an extended lesion.The severity of airway obstruction was determined using Myer-Cotton grading system and forty- one patients (73.2%) had ≥ 71% airway lumen obstruction (Grade III or IV). In 10 cases tracheoesophageal fistula was detected. Tracheoesophageal fistula was more common in esophageal cancer patients (p<0.05). An equal number of silicone (n=28) and metallic (n=28) stents were placed.Twenty-one (37.5%) stents were associated with ≥1 complication, such as mucostasis (n=18), migration (n=3), tumor in-growth (n=15), granulation tissue (n=9) and halitosis (n=4).The overall median stenting time was 66 (32-247) days.The median number of complications was 2.0 (2-3).There was a statistically significant difference between the frequency of complications and the presence of grade III or IV obstruction (p<0.05) and in patients with a y-stent (p<0.05). The median time until first complication was 39 (16-96) days. The time until first complication was independent of the type of stent (p=0.231), the grade or extension of the obstruction (p=0.401 and p=0.436, respectively). Stent was removed and replaced in 4 and 6 cases, respectively.The median survival of patients was 68 (32-247) days.The median time until death was 145 (70-338) days for patients with stent-related complications and 59 (28-103) days for patients without complications, this difference was the only statistically significant (p<0.05).
Conclusion: Although airway stenting is a valuable treatment in MCAO patients, complications develop in a significant number of cases, being more frequent in patients with longer survival.
AIRWAY STENTS IN MALIGNANT CENTRAL AIRWAY OBSTRUCTION
Mariana Serino
Centro Hospitalar Universitário De São João, Porto, Portugal
40 6th European Congress for Bronchology and Interventional Pulmonology