Abstract
A 72-year-old man who underwent a curative resection for a thoracic esophageal cancer in June 1996, developed dyspnea in March 1997. Chest CT revealed recurrence and infiltration at the tracheal bifurcation, causing complete obstruction of the left main bronchus and atelectasis of the left lower lobe. Although radiotherapy was initiated immediately, his dyspnea became more severe, so an expandable metallic stent (EMS) was placed at the site of obstruction on April 1. On the next day after setting, dilatation of the tracheal lumen was achieved to the maximum diameter of EMS without pain or persistent cough. There was a striking improvement in his dyspnea and atelectasis. Four months after the EMS placement, the patient died from exacerbation of pleural effusion and intra-airway bleeding due to perforation of a mediastinal blood vessel by progression of the local lesion.
EMS placement for airway obstruction had been suggested to be associated with the risks of hemorrhage on insertion of the dilator and fistula formation to adjacent structures throught long-term pressure from the expandable stent, but it was actually less invasive and dramatically improved the quality of life in this case. EMS insertion is particularly useful in patients with terminal cancer, and should be more widely used in the future.
