Evaluate long-term decannulation rate and its predictive factors for patients with benign TS deemed to be inoperable for whom silicone stents were considered definitive treatment.
Retrospective analysis of all patients who underwent tracheal stents implantation as definitive treatment for benign TS in our facility from January/98 until January/08. We considered successful decannulation when 6 months after the stent removal the patient remained free of symptoms and no additional dilatational procedure was required. Predictive factors analyzed were: gender, age, stenosis features (according to CT scan/bronchoscopy), previous tracheostomy, time interval from TS diagnosis and stenting.
92 patients (60 men, 32 women), age average 38.7 ± 18 years, were included. TS etiology was prolonged orotracheal intubation (84) and other(8). Surgical treatment was precluded because of severe clinical comorbidities (41), long segment-stenosis (37) or they were waiting for other interventions under general anesthesia (12). Average TS distance from vocal folds was 2.6±1.3 cm and average TS length, 4.3±1.5 cm. Sixty-five patients underwent T-tube insertion, 15 a Dumon stent and 12 both (during their follow-up). They underwent an average of 2.6 stent changes. Twenty-one patients were decannulated after a mean time of 25±18 months; nevertheless two of them were recannulated after 6 months. None of the factors discriminated in the method section correlated with successful decannulation. The mean follow-up time was 50.9±35.7 months, there was no difference in follow-up time between those who were decannulated or not. Currently 63 patients are still being followed (12 of them decannulated), 20 were lost to follow-up (8 decannulated) and 9 died (of unrelated causes).
Tracheal stenting for benign TS demands several interventions (stent changes) and is associated with a low decannulation rate. No predictive factor of success was identified in the present study.
This long-term study on tracheal stenting for benign TS demonstrated that this procedure has a low rate of decannulation and that demographic and stenosis features can not predict the outcome. Hence, new strategies should be developed for long-term resolution.
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