Outcomes of Therapeutic Bronchoscopy and Airway Stenting for Benign and Malignant Central Airway Diseases in Malaysia: A Tertiary Centre Experience = Outcomes of Therapeutic Bronchoscopy and Airway Stenting for Benign and Malignant Central Airway Diseases in Malaysia: A Tertiary Centre Experience

다국어 초록 (Multilingual Abstract)

Introduction
Therapeutic bronchoscopy and airway stenting are acceptable measures for managing patients with severe symptomatic benign and/or malignant central airway diseases(CAD). Nevertheless, gaps in knowledge still exist in real-life clinical setting regarding predictors of both successful procedure and stent-related complications. The objective of this study was to determine if demographics, clinical presentation, radiological features, bronchoscopy findings and stent characteristics can identify patients who will benefit and/or develop complications from airway stenting.
Methods
Post-hoc analysis of patients with severe symptomatic benign/malignant CAD who underwent therapeutic bronchoscopy and airway stenting from January 2018 - January 2021.
Results
We included 24 patients(58.3%male) with median age of 51.0years. 14(58.3%) had malignant conditions and 10(41.7%) had benign disease. Presenting symptoms included cough(87.5%), dyspnoea(83.3%), orthopnoea(29.2%), and stridor(16.7%). Of radiological features: 54.2% had tracheal involvement, 50.0% main bronchus involvement, and 91.2% had patent airways distal to CAD. Equal number of cases(12 each) were conducted as emergency(performed within 1-day from presentation) and as semi-emergency(performed within 1-week from presentation). Bronchoscopy revealed that 54.2% had pure intrinsic lesions, 20.8% pure extrinsic lesions and 25.0% mixed lesions. 20.8% had concurrent bronchomalacia. Of stent characteristics, 62.5% received metallic stents, 33.3% silicone and 4.2% hybrid stents. Majority(75%) expressed immediate symptom relief after stenting. There was no intra-procedure mortality and complications were observed in 11(45.8%) patients, where obstruction by granulation tissue/tumour overgrowth being the most common complication(42.9%), followed by stent migration(28.6%), obstruction by secretion(14.3%) and airway tear/injuries(14.3%). There was significant association between the absence of bronchomalacia and successful procedure(Cramer’sV=0.515,p<0.05). Semi-emergency procedures(as opposed to emergency procedures) were associated with a successful outcome(Cramer’sV=0.507,p<0.05).
Discussion and Conclusion
Airway stenting is an effective procedure that offers rapid relief in symptoms but at the expense of potential complications. Further large-scale studies are required to identify predictors of both successful procedure and airway stenting related complications among patients with both benign and malignant CAD.