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Original Research: CANCER |

Respiratory Infections Increase the Risk of Granulation Tissue Formation Following Airway Stenting in Patients With Malignant Airway ObstructionAirway Stent Complications

David E. Ost, MD, MPH, FCCP; Archan M. Shah, MD; Xiudong Lei, PhD; Myrna C. B. Godoy, MD, PhD; Carlos A. Jimenez, MD, FCCP; George A. Eapen, MD, FCCP; Pushan Jani, MD; Andrew J. Larson, MSN; Mona G. Sarkiss, MD, PhD; Rodolfo C. Morice, MD, FCCP
Author and Funding Information

From the Department of Pulmonary Medicine (Drs Ost, Shah, Jimenez, Eapen, Jani, and Morice and Mr Larson), the Department of Biostatistics (Dr Lei), the Department of Diagnostic Radiology (Dr Godoy), and the Department of Anesthesia (Dr Sarkiss), The University of Texas MD Anderson Cancer Center, Houston, TX.

Correspondence to: David Ost, MD, MPH, FCCP, The University of Texas MD Anderson Cancer Center, Department of Pulmonary Medicine, Unit 1462, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: dost@mdanderson.org


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1473-1481. doi:10.1378/chest.11-2005
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Background:  The most serious complications of airway stenting are long term, including infection and granulation tissue formation. However, to our knowledge, no studies have quantified the incidence rate of long-term complications for different stents.

Methods:  To compare the incidence of complications of different airway stents, we conducted a retrospective cohort study of all patients at our institution who had airway stenting for malignant airway obstruction from January 2005 to August 2010. Patients were excluded if more than one type of stent was in place at the same time. Complications recorded were lower respiratory tract infections, stent migration, granulation tissue, mucus plugging requiring intervention, tumor overgrowth, and stent fracture.

Results:  One hundred seventy-two patients with 195 stent procedures were included. Aero stents were associated with an increased risk of infection (hazard ratio [HR] = 1.98; 95% CI, 1.03-3.81; P = .041). Dumon silicone tube stents had an increased risk of migration (HR = 3.52; 95% CI, 1.41-8.82; P = .007). Silicone stents (HR = 3.32; 95% CI, 1.59-6.93; P = .001) and lower respiratory tract infections (HR = 5.69; 95% CI, 2.60-12.42; P < .001) increased the risk of granulation tissue. Lower respiratory tract infections were associated with decreased survival (HR = 1.57; 95% CI, 1.11-2.21; P = .011).

Conclusions:  Significant differences exist among airway stents in terms of infection, migration, and granulation tissue formation. These complications, in turn, are associated with significant morbidity and mortality. Granulation tissue formation develops because of repetitive motion trauma and infection.

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