Is Airway Stent a Definitive Treatment for Management of Malignant Central Airway Obstruction?

Airway stents are a palliative treatment for malignant central airway obstruction (MCAO). Reopening airways improves symptoms so that patients can undergo additional treatments such as chemo/radiotherapy. Airway stents may be withdrawn in case of tumoral response to treatment. However, stent fracture and airway injury are some complications reported after stent removal. Herein, we evaluated the feasibility of stent removal after MCAO.

This was a retrospective study including consecutive patients treated with airway self-expandable metallic stent insertion and subsequent chemo/radiotherapy for MCAO between June 2018 and June 2024 at our institution. Patients were divided in 2 groups: stent removal group and control group. The decision of removing the airway stent was based on response to therapy.

Of the 72 included patients, 14 underwent stent removal. The median interval between stent placement and removal was 6 months and no intra- or periprocedural complications were observed. In 3 cases, the stent was removed after dislocation consequent to the tumoral response. Stent removal was associated with significant reduction of bronchoaspiration, infection, and granulation tissue formation, in addition to an increased overall survival (P = .029) and a lower 90-day mortality (P = .05) due to the better response to the therapy.

Airway stent removal after chemo/radiotherapy is safe and feasible, and not associated with severe complications in expert hands. In case of significant reduction of the tumor, patients should be considered for stent removal to reduce complications related to the stent presence.