SESSION TITLE: Interventional Pulmonary
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 25, 2015 at 04:30 PM - 05:30 PM
PURPOSE: To evaluate the median survival and the predictors of mortality in patients undergoing endoscopic treatment of neoplastic airway obstruction. The secondary objective is to evaluate the morbidity of the procedure.
METHODS: Retrospective study, from January 2010 to December 2014. All data was collected until February 2015. We included patients with neoplastic obstruction of the trachea and bronchi, that underwent endoscopic treatment. Procedures were performed in the operating room under general anesthesia, through rigid bronchoscopy or suspension laryngoscopy. Age, sex, neoadjuant chemo-radiotherapy, adjuvant chemo-radiotherapy, ECOG status, ASA status, urgent procedures, need for mechanical ventilation, reintervention procedures, site of obstruction, type of stent and tumor histology were considered predictors for mortality. The median survival was analyzed by Kaplan-Meier curve. Prognostic factors of mortality were analyzed by Cox regression.
RESULTS: We included 42 patients (25M / 17F) with a mean age of 54 + 11 years, that underwent 68 endoscopic procedures. The most common histologic types were lung cancer (n = 15; 36%), esophagus (n = 11; 26%) and cystic adenoid carcinoma (n = 8; 19%). Twenty-five stents were placed. The silicone Y stent was the most common (n=14;56%). Eleven percent of patients required a tracheostomy. Complications occurred in 37.5% of cases; pneumonia (n = 10; 15%) and stent obstruction (n = 6; 9%) were the most frequent. The median survival was 221 days. The 30-day mortality was 14%, and overall mortality 40%. The predictors of mortality by Cox regression were re-intervention procedures (HR 5.9; p <0.001; 95% CI 2:25 to 15:45), mechanical ventilation before the procedure (HR 7:38; p = 0.015; 95% CI: 1.46- 37) and tumor hystology (HR: .23; p <0.001; 95% CI: .11 - .47). Individuals with esophageal cancer had a significant lower median survival, when compared with lung cancer and cystic adenoid carcinoma (94 vs 166 vs 346 days; p=0.002).
CONCLUSIONS: The morbidity and mortality of patients submitted to endoscopic treatment of neoplastic airway obstruction is not negligible. Reintervention procedures, mechanical ventilation prior to treatment and tumor histology were significant predictors of mortality.
CLINICAL IMPLICATIONS: Malignant obstruction of the airways is frequent in advanced stages of disease. Identification of predictors for mortality may prevent futile procedures. Best supportive care may be chosen, instead of invasive measures, in selected patients.
DISCLOSURE: The following authors have nothing to disclose: Benoit Bibas, Oswaldo Gomes-Junior, Helio Minamoto, Paulo Cardoso, Ricardo Terra, Mauro Tamagno, Paulo Pêgo-Fernandes
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