PURPOSE: Despite advances of endoscopic techniques in the treatment of airways stenosis, it still shows drawbacks due to scar tissue formation at the stenotic site. Mitomycin C (MC), has been used to prevent the formation of such scars. The purpose of this study is to assess the effectiveness of MC in the conservative treatment of airways stenosis in a referral university hospital.
METHODS: This prospective study included patients with lower airway stenosis treated by dilatation and topical MC (0.5mg/mL). This treatment was indicated to patients unable to undergo tracheoplasty, with membranous stenosis that had good response to dilatation, and patients with immature stenosis and active inflammatory process. Treatment was discontinued in case of MC-induced complication, unresponsiveness to the first application, and incomplete resolution with indication of surgical repair. Data analysis included age, gender, etiology, stenosis site, stenosis length, narrowing area (radius circumference), tracheotomy-dependent, number of dilatations with MC application, success or failure of treatment, follow-up length and complications.
RESULTS: Twenty-two patients were treated between 2003 and 2009. Of these, 14 were males and eight females. Stenosis causes were orotracheal intubation in 15 patients and postoperative stenosis in seven. Tracheal stensosis was the most frequent (14 cases) whereas laryngotracheal and tracheobronchial stenoses showed similar frequency (four each). Stenosis length ranged from 0.5 to 2.5cm (Mean=1.25cm) with narrowing area ranging from 40 to 100% (Mean=76%) of the airway size. The presence of tracheotomy prior to admission was reported in nine patients who were the only ones to receive silicone prosthesis. A mean procedures performed per patient were 2.33. The success of treatment was observed in 14 cases (65%) with the average follow-up of three years.
CONCLUSION: MC was effective after exclusive dilatation, especially because it made possible to maintain the airway size even without the placement of an prosthesis, and allowed the achievement of successful endoscopic treatment in more than half of the cases.
CLINICAL IMPLICATIONS: It may be an alternative in the treatment of patients that cannot undergo surgery.
DISCLOSURE: Daniele Cataneo, No Financial Disclosure Information; No Product/Research Disclosure Information