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Messina G, Pica DG, Vicario G, Bove M, Natale G, Di Filippo V, Capasso F, Mirra R, Panini D’Alba F, Conzo G, Posta TD, Giorgiano NM, Vicidomini G, Capaccio D, Peritore V, Teodonio L, Andreetti C, Rendina EA, Fiorelli A. Advances in Endoscopic Management of Endobronchial Carcinoid. J Clin Med 2023; 12:5337. [PMID: 37629378 PMCID: PMC10455501 DOI: 10.3390/jcm12165337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20-30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to review the results of endoscopic treatments as an alternative to surgical treatment in selected patients. MATERIALS AND METHODS The present study was a retrospective and multicentric study, in which all data were reviewed for patients with BC in the central airways, referred to the Thoracic Surgery Units of Luigi Vanvitelli University of Naples and Sant'Andrea Hospital in Rome between October 2012 and December 2022 Overall, 35 patients, 13 of whom were female, were included in the study (median age, 53 years; range, 29-75 years). All patients underwent rigid bronchoscopy combined with flexible bronchoscopy. Tumor clearance was mostly performed by use of Argon Plasma Coagulation or Thulep Laser, mechanical debridement and excision with the use of forceps and aspirator through the working channel of the 8.5 mm-sized rigid bronchoscope. There were no complications during the treatment. RESULTS Endobronchial treatment provided complete tumor eradication in all patients; two patients had controlled bleeding complications; however, bleeding was well controlled without patient desaturation, and only one patient died of renal failure during the follow-up period. We found two recurrences in the left and right main bronchus, in patients with atypical carcinoma during fiberoptic bronchoscopy follow-up. Only one patient died of renal failure. At the first analysis, there were no significant differences between the patients receiving endobronchial treatment and patients receiving surgical treatment in the present study (p-value > 0.05-it means statistically insignificant). CONCLUSIONS Endobronchial treatment is a valid and effective alternative for patients with BC unsuitable for surgery.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Davide Gerardo Pica
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Giuseppe Vicario
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Mary Bove
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Francesca Capasso
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Rosa Mirra
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Francesco Panini D’Alba
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Giovanni Conzo
- Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.C.)
| | - Tecla Della Posta
- Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.C.)
| | - Noemi Maria Giorgiano
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
| | - Damiano Capaccio
- Operative Unit of Endoscopy and Respiratory Pathophysiology, “Maria Santissima Addolorata” Hospital, 84025 Eboli, Italy;
| | - Valentina Peritore
- Thoracic Surgery Unit, Sant’Andrea Hospital, La Sapienza—Università di Roma, 00189 Roma, Italy; (V.P.); (L.T.); (C.A.); (E.A.R.)
| | - Leonardo Teodonio
- Thoracic Surgery Unit, Sant’Andrea Hospital, La Sapienza—Università di Roma, 00189 Roma, Italy; (V.P.); (L.T.); (C.A.); (E.A.R.)
| | - Claudio Andreetti
- Thoracic Surgery Unit, Sant’Andrea Hospital, La Sapienza—Università di Roma, 00189 Roma, Italy; (V.P.); (L.T.); (C.A.); (E.A.R.)
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant’Andrea Hospital, La Sapienza—Università di Roma, 00189 Roma, Italy; (V.P.); (L.T.); (C.A.); (E.A.R.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (D.G.P.); (G.V.); (M.B.); (G.N.); (F.C.); (R.M.); (F.P.D.); (N.M.G.); (G.V.); (A.F.)
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Wei J, Qin S, Li W, Chen Y, Feng T, Wei Y, Tan S, Liu G. Analysis of clinical characteristics of 617 patients with benign airway stenosis. Front Med (Lausanne) 2023; 10:1202309. [PMID: 37547601 PMCID: PMC10397385 DOI: 10.3389/fmed.2023.1202309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Benign airway stenosis (BAS), namely airway narrowing caused by a variety of benign lesions, can lead to varying degrees of breathing difficulties and even death due to asphyxia. This study aimed to elucidate the clinical characteristics of BAS, including etiology, treatment and pathology, by analyzing the clinical data of BAS patients. Methods A retrospective analysis was conducted using the clinical data of 617 BAS cases from January 2017 to December 2022. The pathological characteristics of the tissues were assessed by hematoxylin-eosin (H&E) and Masson's staining. Besides, protein expression levels were determined by immunohistochemistry (IHC). Results A total of 617 patients were included (333 females [53.97%] and 284 males [46.03%]), with an average age of 48.93 ± 18.30 (range 14-87). Tuberculosis (n = 306, 49.59%) and trauma (n = 179, 29.02%) were the two leading etiologies of BAS, followed by airway foreign bodies (FB, n = 74, 11.99%), external compression (n = 25, 4.05%) and other etiologies (n = 33, 5.35%). Among 306 tuberculous tracheobronchial stenosis (TBTS) cases, most were females (n = 215, 70.26%), and TBTS mainly occurred in the left main bronchus (n = 97, 31.70%), followed by the right middle bronchus (n = 70 cases, 22.88%). The majority of TBTS patients (n = 259, 84.64%) were treated by interventional therapy. The condition of 179 BAS patients was ascribed to trauma, such as tracheal intubation (n = 92, 51.40%), tracheotomy (n = 69, 38.56%), injury (n = 15, 8.38%) and surgery (n = 3, 1.68%), which mostly took place in the trachea (n = 173, 96.65%). TAS patients mainly received interventional therapy (n = 168, 93.85%) and stent implantation (n = 47, 26.26%). The granulation tissues of BAS primarily featured inflammation, proliferation and fibrosis. IHC indicated the up-regulated expressions of transforming growth factor-β1 (TGF-β1), α-smooth muscle actin (α-SMA), collagen type I protein (COL-I) and vimentin, and the down-regulated expression of E-cadherin, which indicated fibrosis and epithelial-mesenchymal transition (EMT). Conclusion Tuberculosis was the main etiology, and trauma was the secondary etiology. The granulation tissues of BAS were characterized by inflammation, fibrosis and probably EMT. Comprehensive interventional therapy is an effective method of treating BAS.
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Affiliation(s)
- Jinmei Wei
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Medical University, Nanning, China
| | - Shujuan Qin
- Guangxi Medical University, Nanning, China
- Department of Pulmonary and Critical Care Medicine, Guigang City People's Hospital, Guigang, China
| | - Wentao Li
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Chen
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tingmei Feng
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuhui Wei
- Guangxi Medical University, Nanning, China
| | - Sen Tan
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guangnan Liu
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Medical University, Nanning, China
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Hong PY, Huang MH, Zhan FF, Lin YL, Qiu SZ, Zhang XB. Case series: Montgomery T-tube placement for subglottic tracheal stenosis: a report of 3 cases. Medicine (Baltimore) 2023; 102:e32680. [PMID: 36637935 PMCID: PMC9839252 DOI: 10.1097/md.0000000000032680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Subglottic tracheal stenosis is stenosis of the trachea between the vocal cords and the lower margin of the cricoid cartilage. The Montgomery T-tube is used as a tracheostomy tube and a combined tracheal stent to avoid postoperative tracheal stenosis. PATIENT CONCERNS Because the stenosis is close to the glottis, surgical treatment is complex, and many complications may arise. DIAGNOSES Subglottic tracheal stenosis. INTERVENTIONS The patients underwent endotracheal intubation or tracheotomy because of acute pancreatitis, laryngeal malignancy, or cerebral hemorrhage after endotracheal intubation or tracheotomy and presented with varying degrees of tracheal stenosis and dyspnea. We relieved airway stenosis and improved dyspnea in these 3 patients by placing a Montgomery T-tube. OUTCOMES None of the 3 patients had intraoperative complications. In 2 of the cases, airway secretions were stored after surgery. LESSONS Montgomery T-tube placement is safe and effective for patients with complex subglottic tracheal stenosis.
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Affiliation(s)
- Ping-Yang Hong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Mao-Hong Huang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Feng-Fu Zhan
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Yi-Li Lin
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Shao-Zhao Qiu
- Department of Anesthesia, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University, Fujian, China
| | - Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
- * Correspondence: Xiao-Bin Zhang, Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, No.201, Hubin Nan Road, Siming District, Xiamen, Fujian Province 361004, China (e-mail: )
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Ming W, Zuo J, Han J, Chen J. The efficiency of endoscopic versus open surgical interventions in adult benign laryngotracheal stenosis: a meta-analysis. Eur Arch Otorhinolaryngol 2022; 280:2421-2433. [PMID: 36585989 DOI: 10.1007/s00405-022-07797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The optimal treatments for adult benign laryngotracheal stenosis presently remains controversial. The majority of the disadvantages of endoscopic interventions with high recurrence rate and open surgical therapy accompanied by sophisticated techniques, complication and mortality, highlights the dilemma of option for treatments. PURPOSE To compare endoscopic treatments with open surgical interventions in adult patients with benign laryngotracheal stenosis, analyze their clinical outcomes, recurrence, complication and mortality. METHODS In the meta-analysis, the databases including PubMed, Embase, Ovid and Web of Science were searched for studies reporting adult benign laryngotracheal stenosis, and clinical outcomes were compared. The duplicate publications, reviews, comments or letters, conference abstracts, case reports were excluded. The random effect model was used for calculating the pooled effect estimates. RESULTS Eight studies (1627 cases) referring to six retrospective and two prospective researches were ultimately included in the meta-analysis. The decreased risk estimates of recurrence rate in patients receiving open surgical interventions were detected, comparing with endoscopic interventions (P < 0.05). Subgroup analysis revealed that decreased risk estimates of restenosis rate were also observed in patients receiving open surgical interventions compared with endoscopic interventions (P < 0.05), based on prospective studies, Europe and America, < 2-year follow-up, laryngeal stenosis, stenotic length without inter-group difference or stenotic grade II alone. However, there were no statistically significant difference of recurrence rate between the two interventions (P > 0.05) based on retrospective studies, South Asia and Africa, ≥ 2-year follow-up, involving tracheal lesion, stenotic length with inter-group difference, or stenotic grades of I-IV. No notable difference in the incidence of complication or mortality were identified. CONCLUSIONS Open surgical interventions were more suitable for most laryngotracheal stenosis without contraindications. Endoscopic interventions are increasingly being used to treat simple laryngotracheal stenosis, as well as complex airway stenosis in carefully selected cases. Multi-center prospective randomized controlled trials should be conducted to search for the standard treatments for laryngotracheal stenosis.
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Affiliation(s)
- Wei Ming
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Jingjing Zuo
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jibo Han
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jinhui Chen
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Hofmeyr R, McGuire J, Park K, Proxenos M, Peer S, Lehmann M, Lubbe D. Prospective Observational Trial of a Nonocclusive Dilatation Balloon in the Management of Tracheal Stenosis. J Cardiothorac Vasc Anesth 2022; 36:3008-3014. [PMID: 35337744 DOI: 10.1053/j.jvca.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Tracheal stenosis is a debilitating condition that often presents as an emergency and is challenging to treat. Dilatation may avoid tracheostomy or costly tracheal resection and reconstruction. Traditional dilators cause complete occlusion, preventing oxygenation and ventilation, limiting the safe duration of dilatation, and increasing the risk of hypoxic injury or barotrauma. The study authors here assessed an innovative nonocclusive tracheal dilatation balloon, which may improve patient safety by allowing continuous gas exchange. DESIGN A prospective observational study of 20 discrete dilatation procedures performed in 13 patients under general anesthesia. The primary outcomes were the ability to ventilate during dilatation and the preservation of peripheral oxygen saturation. Secondary outcomes included a measured reduction in stenosis, improvement in Cotton-Myer grading, and procedure-related adverse events. SETTING At a single university (academic) hospital. PARTICIPANTS Consenting adult patients with acquired tracheal stenosis. INTERVENTIONS Access to the airway was maintained by a rigid bronchoscope or supraglottic airway device, as deemed appropriate. Continuous conventional ventilation was provided during 3-minute balloon dilatations. MEASUREMENTS AND MAIN RESULTS Heart rate, airway pressure, end-tidal carbon dioxide partial pressure, and peripheral oxygen saturation were measured, and adverse events were recorded. Ventilation was satisfactory in all patients. Peripheral saturation remained greater than 94% in 19 of the 20 (95%) procedures. Stenosis internal diameter and grading were improved. Two patients had minor reversible adverse events (coughing and laryngospasm), which did not prevent completion of the procedure. CONCLUSIONS The authors report the first human trial of the device, in which continuous conventional ventilation could be provided during all tracheal balloon dilatation procedures. Larger trials are needed to confirm improved patient safety and comparative efficacy.
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Affiliation(s)
- Ross Hofmeyr
- Associate Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Jessica McGuire
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kenneth Park
- (formerly) DISA Medinotec, Johannesburg, South Africa
| | | | - Shazia Peer
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Darlene Lubbe
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Aydogmus U, Ozturk G, Kis A, Karakaya YA, Aybek H, Bir F. An Experimental Study on Timing in Tracheal Stenosis Surgery. Thorac Cardiovasc Surg 2021; 70:513-519. [DOI: 10.1055/s-0041-1740308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background TNF-α, IL-6, and TGF-β are important bio mediators of the inflammatory process. This experimental study has investigated inflammatory biomarkers' efficacy to determine the appropriate period for anastomosis surgery in tracheal stenosis cases.
Methods First, a pilot study was performed to determine the mean stenosis ratio (SR) after the surgical anastomosis. The trial was planned on 44 rats in four groups based on the pilot study's data. Tracheal inflammation and stenosis were created in each rat by using micro scissors. In rats of groups I, II, III, and IV, respectively, tracheal resection and anastomosis surgery were applied on the 2nd, 4th, 6th, 8th weeks after the damage. The animals were euthanized 8 weeks later, followed by histopathological assessment and analysis of TNF-α, IL-6, and TGF-β as biochemical markers.
Results Mean SR of the trachea were measured as 21.9 ± 6.0%, 24.1 ± 10.4%, 25.8 ± 9.1%, and 19.6 ± 9.2% for Groups I to IV, respectively. While Group III had the worst SR, Group IV had the best ratio (p = 0.03). Group II had the highest values for the biochemical markers tested. We observed a statistically significant correlation between only histopathological changes and TNF-α from among the biochemical markers tested (p = 0.02). It was found that high TNF-α levels were in a relationship with higher SR (p = 0.01).
Conclusion Tracheal anastomosis for post-traumatic stenosis is likely to be less successful during the 4th and 6th weeks after injury. High TNF-α levels are potentially predictive of lower surgical success. These results need to be confirmed by human studies.
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Affiliation(s)
- Umit Aydogmus
- Department of Thoracic Surgery, Pamukkale University Hospital, Denizli, Turkey
| | - Gokhan Ozturk
- Department of Thoracic Surgery, Pamukkale University Hospital, Denizli, Turkey
| | - Argun Kis
- Department of Thoracic Surgery, Pamukkale University Hospital, Denizli, Turkey
| | | | - Hulya Aybek
- Department of Medical Biochemistry, Pamukkale University Hospital, Denizli, Turkey
| | - Ferda Bir
- Department of Medical Pathology, Pamukkale University Hospital, Denizli, Turkey
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