0
Pulmonary Procedures |

Survival and Predictors of Mortality in Patients Submitted to Endoscopic Treatment of Malignant Airway Obstruction

Benoit Bibas, MD; Oswaldo Gomes-Junior, MD; Helio Minamoto, MD; Paulo Cardoso, PhD; Ricardo Terra, MPH; Mauro Tamagno, MD; Paulo Pêgo-Fernandes, PhD
Author and Funding Information

Thoracic Surgery, University of São Paulo, Brazil, São Paulo, São Paulo, Brazil


Chest. 2015;148(4_MeetingAbstracts):797A. doi:10.1378/chest.2275852
Text Size: A A A
Published online

Abstract

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

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543