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Ann Thorac Surg 2000;70:1197-1201
© 2000 The Society of Thoracic Surgeons

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Original articles: general thoracic

Malignant laryngotracheal obstruction: a way to treat serial stenoses of the upper airways

^a Third Medical Department, University of Cologne, Cologne, Germany
^b Ear, Nose and Throat Department, University of Cologne, Cologne, Germany

Address reprint requests to Dr Klaus Wassermann, Klinik III für Innere Medizin der Universität zu Köln, Gebäude 0/D, Raum 409, Josef-Stelzmann-Strasse 9, 50924 Köln, Germany

Background. Six patients known to have inoperable esophageal carcinoma presented with stridor due to both malignant tracheal stenosis (n = 6) and bilateral vocal cord paralysis. Two patients also had respiratory-digestive fistula.

Methods. Patency was restored by endotracheal stenting plus unilateral cordectomy. Four patients had immediate relief. Two patients required enlargement of the cord incision. One of them declined reoperation and underwent tracheotomy.

Results. Stent function was uneventful. There was no dislodgement or mucous impaction. Fistula seal was complete. There was no aspiration through the new-shaped glottic orifice. Peak expiratory flow increased from 24.4% ± 9.7% predicted normal before to 40.5% ± 13.7% after the procedure, whereas the dyspnea score decreased from 74.2 ± 12.7 to 24.2 ± 14.0.

Conclusions. Restoration of airway continuity in serial laryngotracheal stenoses using a combined approach is a feasible technique in end-stage cancer patients. It effectively relieves respiratory distress and ensures voice preservation. In addition, it may avoid the risks of tracheotomy.