Endobronchial silicone stenting through tracheostomy is a life - saving technique for advanced esophageal cancer patients who present with tracheal stenosis: An institution’s experience

Endobronchial silicone stenting through tracheostomy is a life - saving technique for advanced esophageal cancer patients who present with tracheal stenosis: An institution’s experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endobronchial silicone stenting through tracheostomy is a life - saving technique for advanced esophageal cancer patients who present with tracheal stenosis: An institution’s experience Dang Nguyen Van, Hung Nguyen Tien, Dung Tran Trung, Manh Pham Duy, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4581280/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Patients with advanced esophageal cancer often present with airway obstruction symptoms requiring emergency intervention. At the Vietnam National Cancer Hospital (VNCH), silicone stents, typically inserted via rigid bronchoscopy, were instead effectively placed through tracheostomy, yielding positive outcomes. Methods: From June 2019 to December 2023, 40 esophageal cancer patients with dyspnea due to tracheal blockage received airway silicone stenting by tracheostomy at the ENT Department at the VNCH. Results: The mean age was 57.4± 9.0 years, ranging from 36 to 79 years. All patients were male (100%). Most patients had a 2-6 cm narrowing segment (87.5%). Most patients had airway stenosis due to compression (77.5%). Approximately one-third of all patients had grade I, II, or III airway stenosis, according to the Cotton-Myers classification. Intraoperatively, only 3 patients experienced hemorrhage (7.5%), which was controlled well by using bipolar coagulation forceps. Noneof the patients had serious complications, such as pneumomediastinum, actelasia, or acute respiratory failure. The only complication that occurred was mucus plugging inthe stent (30%), which was quickly resolved by draining through the tracheostomy. Most patients (92.5%) had SpO2 lower than 95% before surgery. After the procedure, all the patients had a normal SpO2 (SpO2 ≥ 95%). Conclusion: Silicone stenting through tracheostomy in respiratory distress patients is safe, cost-effective, and valuable for the management of airway involvement in esophageal cancer patients. Our approach could be a good option for other centers to apply, especially in countries with healthcare resource constraints. Endobronchial silicone esophageal cancer tracheal stenosis Figures Figure 1 Figure 2 Figure 3 I. INTRODUCTION According to GLOBOCAN 2022, esophageal cancer is one of the leading causes of cancer-related fatalities worldwide, with a mortality rate of 4.3 per 100 000 adjusted for age. 1 This could be attributable to the fact that more than 70% of individuals initially diagnosed with this disease were in advanced stages. Although dysphagia is the most prevalent symptom of esophageal tumors, some patients experience airway obstruction symptoms, which may necessitate emergency care. In the past, endobronchial metallic stenting was commonly used for ree-dilating the airway, but it is costly and difficult to remove if the stent migrates. 2 – 4 Therefore, silicone stents with cost-effective characteristics that are easy to replace have gained more favor and have replaced their metallic counterparts in the treatment of malignant tracheal obstruction. 3 , 5 Since June 2019, silicone stents have been utilized to treat this deadly illness at Vietnam National Cancer Hospital. In lieu of placing the silicone stent by rigid bronchoscopy, we chose to perform a tracheostomy and subsequently implant the stent. Over the course of three years, our unique strategy has yielded favorable outcomes. Consequently, we undertook this study to evaluate the efficacy and safety of our method. II. PATIENTS AND METHODS Trial patients The inclusion criteria were 40 esophageal cancer patients with dyspnea due to tracheal obstruction who underwent airway silicone stenting at the ENT Department of Vietnam National Cancer Hospital between June 2019 and December 2023. The stents were deployed through tracheostomy while the patient was under general anesthesia. Patients with an esophageal tumor that had invaded the main bronchus or who were too frail to undergo surgery were excluded from the study. Methods In this prospective study, data from 40 eligible patients were collected for analysis via convenience sampling. The study variables included clinicopathological characteristics, the severity of dyspnea before and after the procedure, the grade of obstruction according to the Myers – Cotton score, the location of the lesion, intraoperative and postoperative complications, and symptom improvement after the operation. Patients were evaluated for symptom improvement immediately after surgery and during their postoperative stay. The statistical analysis was conducted using SPSS 20.0. The Director Board of Vietnam National Cancer Hospital approved this investigation. All the data were used solely for research purposes. Figure 1 depicts information about the technique in detail. Technique (See Figure 1. Briefly, description of our technique) III. RESULTS 3.1. Clinicopathological characteristics The mean age was 57.4± 9.0 years, ranging from 36 to 79 years. All patients were male (100%). Thoracic tumors accounted for 65% of the tumor sites. Most patients had a 2-6 cm narrowing segment (87.5%). Approximately one-third of all patients had grade I, II, or III airway stenosis according to the Cotton–Myers classification. No patients had grade IV stenosis. Most patients had airway stenosis due to compression (77.5%). Six patients had esophageal tumors invading the airway (15%). 3.2. Treatment complications and outcomes Intraoperatively, only 3 patients experienced hemorrhage (7.5%), which was controlled well by using bipolar coagulation forceps. None of the patients had serious complications, such as pneumomediastinum, actelasia, or acute respiratory failure. Seventy percent of all patients had no major complications during their postoperative stay. The only complication that occurred was mucus plugging in the stent (30%), which was resolved by drainage through the tracheostomy. Most patients (92.5%) had SpO2 values lower than 95% before surgery. After the procedure, all of the patients had a normal SpO2 (SpO2 ≥ 95%). Figure 2 and Figure 3 illustrate tracheal stenosis and the airway lumen after the stenting procedure, respectively. IV. DISCUSSION Esophageal cancer can induce airway obstruction via extrinsic compression or direct invasion, requiring rapid intervention under certain circumstances. A study of 804 patients at a tertiary medical institution in Singapore revealed that the incidence of airway involvement (compression or invasion) in patients with advanced esophageal cancer could be as high as 23.5%. 6 This study revealed that airway involvement was associated with decreased survival from the time of diagnosis and more hospitalizations per year, indicating the need for doctors to pay greater attention. 6 To restore the patency of the airway, airway resection and reconstruction are nearly unfeasible, especially in patients with severe dyspnea. In such instances, airway stenting may preserve a patient's life and provide prospects for additional anticancer treatment. 4,7 The benefits of using metallic expandable stents for this purpose have been demonstrated. 4 They can be inserted using flexible bronchoscopy and fluoroscopic guidance, which is easier when only local anesthetic is needed. However, compared to their silicone counterparts, metallic stents have significant limitations, including (i) a greater risk of granulation tissue reaction, which was found to be 5% in a study of 140 patients undergoing metallic stent insertion, and (ii) a greater rate of incorporation into the mucosa by neo-epithelialization characteristics, making it nearly impossible to remove after 3-6 weeks, which is detrimental if a life-threatening stent is present; (iii) a weaker vault effect, making them more susceptible to collapse if the external force is too high; and (iv) being much more expensive, 1.5-2 times as much, making it unaffordable for the majority of patients in developing nations. 2,3,5,8 In light of the aforementioned disadvantages of metallic stents, we opted to employ silicone stents in our investigation. In our analysis, 65% of the patients had thoracic esophageal tumors, and the narrowing section was placed below the tracheostomy site. Therefore, tracheostomy alone is not enough in most cases. In addition, most patients exhibited tracheal stenosis of grades II-III (50-99% of the lumen area). This could be attributable to the dyspnea patient selection criteria. The grade of stenosis is a predictive indicator since it represents the disease's extended course. Patients with high-grade stenosis are also at risk of reocclusion following surgery. When 50% of the airway lumen is occluded, dyspnea upon exercise is present. When 75% of the airway lumen is occluded, orthopnea occurs. 9 In adults, exertional dyspnea occurs when the airway lumen is 8 mm, whereas orthopnea occurs when the airway diameter is 5 mm. 9 All of our subjects exhibited severe airway stenosis resulting in dyspnea, necessitating immediate intervention as recommended. In our investigation, three causes of stenosis were identified: compression, invasion, and mixed type, with compression accounting for the majority (77.5%) of cases. Since there is no cartilage at this location, the esophageal tumor pushes against the posterior wall of the trachea. This variety has a more favorable prognosis and shorter treatment duration. In invasion cases, the tumor infiltrates the entire posterior wall and the airway lumen. This type had a greater risk of complications, particularly intraoperative and postoperative bleeding. Patients with invasive or mixed type endobronchial tumors were treated with a microdebrider and bipolar coagulation, which increased the duration of the procedure. Intraoperatively, three patients had mild hemorrhages, which were managed well by bipolar surgery, all of whom had invasion. Two patients with narrowing segments near the carina had subcutaneous emphysema after tracheal incision due to low tracheostomy. There were no life-threatening complications, such as pneumomediastinum or acute respiratory failure, in our study, which is in concordance with previous studies. 4,10,11 During the postoperative stay, the only complication that occurred was mucus plugging in the stent (30%), which was resolved by draining through the tracheostomy. The SpO2 level was restored to a normal value (SpO2 ≥ 95%) in all patients after the procedure, indicating the effectiveness of this procedure. In addition to the abovementioned advantages of silicone stents, the tracheostomy method employed in our study provided specific advantages. Initially, our strategy could aid patients in terms of rapid reventilation with readily available devices such as microdebriders, bipolar devices, and pince Kochers. Our technique is simple and does not require rigid bronchoscopy with a dedicated rigid loading system, which is absent in the majority of nations with limited financial resources. Thus, our approach could be widely implemented in numerous centers, particularly in developing nations with a dearth of surgical instruments. In addition, our method established a simpler way to treat dyspnea by quickly dilating the stenosis and inserting an endobronchial tube via tracheostomy. After tracheostomy, insertion of an endobronchial tube, and ventilation, the patient’s dyspnea improved significantly, allowing general anesthesia to be administered. This is practically essential since initial general anesthesia before rigid bronchoscopy is a contraindication in acute respiratory failure patients. 12 Thus, the objective of deploying silicone stents through rigid bronchoscopy through the mouth in our patients with respiratory distress was not achievable, making the tracheostomy technique more realistic. In addition, by tracheostomy, the location and severity of stenosis may be examined simply and precisely with an optic or even the naked eye. During the postoperative stay, problems such as mucus clogging and stent migration can be swiftly treated. This saved a great deal of time, as we only required an optic to examine through a tracheostomy, as opposed to a bronchoscopy or X-ray to diagnose in the case of stent deployment via the mouth. Due to the need for a tracheostomy prior to stenting, one of the disadvantages of our approach was that the mean operative time (from tracheostomy to completion of stenting) was greater than that in previous investigations of endoscopic stenting. 2,4,7 This might theoretically increase the likelihood of problems. However, the complication rate was modest in our study, demonstrating that a longer operation time did not compromise the safety of our treatment. In addition, it is indisputable that tracheostomy increases the risk of bleeding, infection, and subcutaneous emphysema. We did not observe any of these problems during the postoperative stay in our study. This could be related to the use of prophylactic antibiotics and our postoperative care expertise. The only postoperative complication that occurred in our patients was mucus plugging, which can theoretically cause severe blockage and even death. However, owing to tracheostomy, this issue could be addressed securely even in the clinical ward. Additionally, the risk of mucus formation can be reduced by nebulizing sterile normal saline into the stent two to three times per day to maintain humidity. CONCLUSION The deployment of a silicone stent through a tracheostomy in patients with respiratory distress is simple, extremely successful, and able to normalize the spO2 level. Overall, our treatment is safe, cost-effective, and beneficial for the therapy of esophageal cancer with airway involvement. Our technique could be a viable option for other centers, particularly in countries with limited healthcare resources. Abbreviations Vietnam National Cancer Hospital (VNCH); Ear Nose Throat (ENT) Declarations Ethics approval and consent to participate: The study was approved by our research committee of Hanoi Medical University, Hanoi, Vietnam, and Vietnam National Cancer Hospital, Hanoi, Vietnam. Patient consent for the publication of this study was obtained. Consent for publication: Written informed consent was obtained from the patients for their anonymized information to be published in this article. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable (there is no funding for this manuscript). Authors' contributions Dang Nguyen Van: Radiation oncologist, treated the patients and wrote the manuscript. Hung Nguyen Tien: Surgeon, treated the patients and wrote the manuscript. Dung Tran Trung: Surgeon, revised manuscript. Manh Pham Duy: Radiation oncologist, revised the manuscript. Acknowledgments: Not applicable References Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834 Xiong XF, Xu L, Fan LL, Cheng DY, Zheng BX. Long-term follow-up of self-expandable metallic stents in benign tracheobronchial stenosis: a retrospective study. BMC Pulm Med. 2019;19(1):33. Published 2019 Feb 8. doi:10.1186/s12890-019-0793-y Guibert N, Saka H, Dutau H. Airway stenting: Technological advancements and its role in interventional pulmonology. Respirology. 2020;25(9):953-962. doi:10.1111/resp.13801 Peng Z, Xu S, Li H, Sun C, Fu M. Metallic expandable stents in the management of malignant tracheal stenosis due to esophageal cancer with lymph node metastasis. Oncology Letters. 2013;6(5):1461-1464. doi:10.3892/ol.2013.1588 Dutau, H. (2013). Endobronchial Silicone Stents for Airway Management. In: Ernst, A., Herth, F. (eds) Principles and Practice of Interventional Pulmonology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4292-9_29 Goh KJ, Lee P, Foo AZX, Tan EH, Ong HS, Hsu AAL. Characteristics and Outcomes of Airway Involvement in Esophageal Cancer. The Annals of Thoracic Surgery. 2021;112(3):912-920. doi:10.1016/j.athoracsur.2020.10.015 Hamai Y, Hihara J, Emi M, Aoki Y, Miyata Y, Okada M. Airway Stenting for Malignant Respiratory Complications in Esophageal Cancer. Anticancer Research. 2012;32(5):1785-1790. Lemaire A, Burfeind WR, Toloza E, et al. Outcomes of tracheobronchial stents in patients with malignant airway disease. Ann Thorac Surg. 2005;80(2):434-437; discussion 437-438. doi:10.1016/j.athoracsur.2005.02.071 Mostafa B, Mbarek C, Halafawi A. Tracheal Stenosis Diagnosis and Treatment.; 2021. ISBN: 10.13140/2.1.3006.9766 Ma G, Yang R, Gu B, Wang D, Liao W, He X. Tracheal stent placement provides opportunity for subsequent anti-cancer therapy for cancer patients with malignant respiratory complications. Ann Palliat Med. 2021;10(2):1042-1049. doi:10.21037/apm-19-419 Miwa K, Matsuo T, Takamori S, et al. Temporary stenting for malignant tracheal stenosis due to esophageal cancer: a case report. Jpn J Clin Oncol. 2002;32(1):27-29. doi:10.1093/jjco/hyf004 Smith G, D'Cruz JR, Rondeau B, Goldman J. General Anesthesia for Surgeons. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 5, 2023. Tables Table 1. Clinicopathological characteristics n % Mean age 57,4± 9,0 (36-79) Gender Male 40 100 Female 0 0 Esophageal tumor location Cervical 14 35 Thoracic 26 65 Length of narro wing segment < 2 cm 3 7,5 ≥ 2 cm and < 4 cm 12 30 ≥ 4 cm and < 6 cm 23 57,5 ≥ 6 cm 2 5 Grade I 12 30 II 15 37,5 III 13 32,5 IV 0 0 Cause of stenosis Invasion 6 15 Compression 31 77,5 Mixed 3 7,5 Table 2 . Treatment complications and outcomes n % Intraoperative complications None 37 87,5 Hemorrhage 3 7,5 Subcutaneous emphysema 2 5 Pneumomediastinum 0 0 Acute respiratory failure 0 0 Death 0 0 Postoperative complications None 28 70 Infection 0 0 Mucus plugging in stent 12 30 Hemorrhage 0 0 Pneumomediastinum 0 0 Subcutaneous emphysema 0 0 Stent migration 0 0 Death 0 0 Preoperative SpO 2 ≥ 95% 3 7,5 < 95% and ≥ 90% 15 37,5 < 90% and ≥ 85% 18 45 < 85% 4 10 Postoperative SpO2 ≥ 95% 40 100 < 95% 0 0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4581280","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":321123248,"identity":"86b0c996-cd94-4677-9804-58f0cfb4877b","order_by":0,"name":"Dang Nguyen Van","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDCCAwwGCM4HIGZjJ0UL4wyQFmZStDDzgEkCOvhuH974ueDXHbsNN5KPPbb5tU2ej5mB8cPHHNxaJM+lFUvP7HuWvOFGWrpxbt9twzZmBmbJmdtwazE4w2MgzdtzONngRo6ZdG7PbUagFjZmXvxajH9DtOR/k7bsuW1PjBYzaZ4fh+2AtrBJM/y4nUhQi+QZtjJr3obDCZJnnplJ9jbcTm5jZmzG6xe+M8ybb/P8OWzPdzz5mcSPP7dt57c3H/zwEY8WMGBsY0hsEEgAM0DcBgLqQeAPgz0D/wEwYxSMglEwCkYBBgAAQqVWFLqpvvAAAAAASUVORK5CYII=","orcid":"","institution":"Vietnam National Cancer Hospital","correspondingAuthor":true,"prefix":"","firstName":"Dang","middleName":"Nguyen","lastName":"Van","suffix":""},{"id":321123249,"identity":"a5c58793-2a58-431f-bcb2-70f07033c767","order_by":1,"name":"Hung Nguyen Tien","email":"","orcid":"","institution":"Vietnam National Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hung","middleName":"Nguyen","lastName":"Tien","suffix":""},{"id":321123250,"identity":"ee00366b-ec19-4aa1-9277-cf5b29274140","order_by":2,"name":"Dung Tran Trung","email":"","orcid":"","institution":"Vietnam National Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dung","middleName":"Tran","lastName":"Trung","suffix":""},{"id":321123251,"identity":"2f4f5a4b-3045-4a7c-8b8b-1043611f8838","order_by":3,"name":"Manh Pham Duy","email":"","orcid":"","institution":"Hanoi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Manh","middleName":"Pham","lastName":"Duy","suffix":""},{"id":321123252,"identity":"9718ef07-ecc0-4bfd-a97e-376dfffddd62","order_by":4,"name":"Tien Kim Thi","email":"","orcid":"","institution":"Vietnam National Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tien","middleName":"Kim","lastName":"Thi","suffix":""}],"badges":[],"createdAt":"2024-06-14 10:10:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4581280/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4581280/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60354467,"identity":"a838f807-3d83-40e2-aaba-056c8464e9ed","added_by":"auto","created_at":"2024-07-15 23:52:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19114,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBriefly description of our technique\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4581280/v1/61faa3a36c9f34b2cf96f4af.png"},{"id":60354466,"identity":"1e8ad7ce-7b32-484a-8131-3844a97b0476","added_by":"auto","created_at":"2024-07-15 23:52:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":102125,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIllustrations of tracheal stenosis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4581280/v1/e78f6270ec3192f9965e8332.png"},{"id":60354465,"identity":"aa9e1b45-edc7-4006-b462-229c385888d3","added_by":"auto","created_at":"2024-07-15 23:52:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":130727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAirway lumen after the stenting procedure\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4581280/v1/c8e29a215feef20eb623735a.png"},{"id":60477409,"identity":"d14752fc-a14f-4364-9bdc-114ec938de21","added_by":"auto","created_at":"2024-07-17 08:02:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":822559,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4581280/v1/0ef2efbb-2fe8-4eb7-b536-447bec56227b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Endobronchial silicone stenting through tracheostomy is a life - saving technique for advanced esophageal cancer patients who present with tracheal stenosis: An institution’s experience","fulltext":[{"header":"I. INTRODUCTION","content":"\u003cp\u003eAccording to GLOBOCAN 2022, esophageal cancer is one of the leading causes of cancer-related fatalities worldwide, with a mortality rate of 4.3 per 100 000 adjusted for age.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e This could be attributable to the fact that more than 70% of individuals initially diagnosed with this disease were in advanced stages. Although dysphagia is the most prevalent symptom of esophageal tumors, some patients experience airway obstruction symptoms, which may necessitate emergency care. In the past, endobronchial metallic stenting was commonly used for ree-dilating the airway, but it is costly and difficult to remove if the stent migrates.\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Therefore, silicone stents with cost-effective characteristics that are easy to replace have gained more favor and have replaced their metallic counterparts in the treatment of malignant tracheal obstruction.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Since June 2019, silicone stents have been utilized to treat this deadly illness at Vietnam National Cancer Hospital. In lieu of placing the silicone stent by rigid bronchoscopy, we chose to perform a tracheostomy and subsequently implant the stent. Over the course of three years, our unique strategy has yielded favorable outcomes. Consequently, we undertook this study to evaluate the efficacy and safety of our method.\u003c/p\u003e"},{"header":"II. PATIENTS AND METHODS","content":"\u003cp\u003e\u003cstrong\u003eTrial\u003c/strong\u003e\u003cstrong\u003epatients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were 40 esophageal cancer patients with dyspnea due to tracheal obstruction who underwent airway silicone stenting at the ENT Department of Vietnam National Cancer Hospital between June 2019 and December 2023. The stents were deployed through tracheostomy while the patient was under general anesthesia. Patients with an esophageal tumor that had invaded the main bronchus or who were too frail to undergo surgery were excluded from the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn\u0026nbsp;this prospective study,\u0026nbsp;data from\u0026nbsp;40 eligible patients were collected for analysis via convenience sampling.\u0026nbsp;The study variables included clinicopathological\u0026nbsp;characteristics,\u0026nbsp;the\u0026nbsp;severity of dyspnea before and after\u0026nbsp;the\u0026nbsp;procedure, the grade of obstruction according to the Myers – Cotton score, the location of the lesion, intraoperative and postoperative complications,\u0026nbsp;and\u0026nbsp;symptom improvement after\u0026nbsp;the\u0026nbsp;operation. Patients were evaluated for symptom improvement immediately after surgery and during their postoperative stay.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe statistical analysis was conducted using SPSS 20.0. The Director Board of Vietnam National Cancer Hospital approved this investigation. All the data were used solely for research purposes. Figure 1 depicts information about the technique in detail.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTechnique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(See \u003cem\u003eFigure 1. Briefly, description of our technique)\u003c/em\u003e\u003c/p\u003e"},{"header":"III. RESULTS","content":"\u003cp\u003e\u003cstrong\u003e3.1. Clinicopathological characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean\u0026nbsp;age was 57.4± 9.0 years, ranging from 36 to 79 years. All patients were male (100%). Thoracic\u0026nbsp;tumors\u0026nbsp;accounted for 65% of\u0026nbsp;the\u0026nbsp;tumor sites. Most patients had a 2-6 cm narrowing segment (87.5%).\u0026nbsp;Approximately one-third of all patients had grade I, II, or III airway stenosis according to\u0026nbsp;the Cotton–Myers classification. No patients\u0026nbsp;had grade IV stenosis. Most patients had airway stenosis due to compression (77.5%). Six patients had esophageal tumors invading the airway (15%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Treatment complications and outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntraoperatively, only 3 patients\u0026nbsp;experienced\u0026nbsp;hemorrhage (7.5%), which was\u0026nbsp;controlled well by using\u0026nbsp;bipolar\u0026nbsp;coagulation forceps. None\u0026nbsp;of the patients\u0026nbsp;had serious complications, such as\u0026nbsp;pneumomediastinum, actelasia, or acute respiratory failure.\u0026nbsp;Seventy percent\u0026nbsp;of all patients had no major complications during their postoperative stay. The only complication\u0026nbsp;that occurred\u0026nbsp;was mucus plugging in\u0026nbsp;the\u0026nbsp;stent (30%), which was\u0026nbsp;resolved\u0026nbsp;by\u0026nbsp;drainage\u0026nbsp;through the tracheostomy.\u0026nbsp;Most patients (92.5%) had SpO2\u0026nbsp;values\u0026nbsp;lower than 95% before surgery. After the procedure, all of\u0026nbsp;the patients\u0026nbsp;had\u0026nbsp;a\u0026nbsp;normal SpO2 (SpO2 ≥ 95%).\u003c/p\u003e\n\u003cp\u003eFigure 2 and Figure 3 illustrate tracheal stenosis and the airway lumen after\u0026nbsp;the\u0026nbsp;stenting procedure, respectively.\u003c/p\u003e"},{"header":"IV. DISCUSSION","content":"\u003cp\u003eEsophageal cancer\u0026nbsp;can\u0026nbsp;induce airway obstruction via extrinsic compression or direct invasion, requiring rapid intervention\u0026nbsp;under\u0026nbsp;certain circumstances. A study of 804 patients at a tertiary medical institution in Singapore revealed that the incidence of airway involvement (compression or invasion) in patients with advanced esophageal cancer could be as high as 23.5%.\u003csup\u003e6\u003c/sup\u003e This study revealed that airway involvement was associated with decreased survival from the time of diagnosis and more hospitalizations per year, indicating the need for doctors to pay greater attention.\u003csup\u003e6\u003c/sup\u003e To restore the patency of the airway, airway resection and reconstruction are nearly unfeasible, especially in patients with severe\u0026nbsp;dyspnea. In such instances, airway stenting may preserve a patient's life and provide prospects for additional\u0026nbsp;anticancer\u0026nbsp;treatment.\u003csup\u003e4,7\u003c/sup\u003e The benefits\u0026nbsp;of using metallic expandable stents for this\u0026nbsp;purpose\u0026nbsp;have been demonstrated.\u003csup\u003e4\u003c/sup\u003e They can be inserted using flexible bronchoscopy and fluoroscopic guidance, which is easier when\u0026nbsp;only\u0026nbsp;local anesthetic is needed. However, compared to their silicone counterparts, metallic stents have significant limitations, including (i) a\u0026nbsp;greater\u0026nbsp;risk of granulation tissue reaction, which was found to be 5% in a study of 140 patients undergoing metallic stent insertion, and (ii) a\u0026nbsp;greater\u0026nbsp;rate of incorporation into the mucosa by neo-epithelialization characteristics, making it nearly impossible to remove after 3-6 weeks, which is detrimental if a life-threatening stent\u0026nbsp;is present;\u0026nbsp;(iii) a weaker vault effect, making them more susceptible to collapse if the external force is too high;\u0026nbsp;and\u0026nbsp;(iv)\u0026nbsp;being\u0026nbsp;much more expensive, 1.5-2 times as much, making it unaffordable for the majority of patients in developing nations.\u003csup\u003e2,3,5,8\u003c/sup\u003e In light of the aforementioned disadvantages of metallic stents, we opted to employ silicone stents in our investigation.\u003c/p\u003e\u003cp\u003eIn our analysis, 65% of the patients had thoracic esophageal tumors, and the narrowing section was placed below the tracheostomy site. Therefore, tracheostomy alone is not enough in most cases. In addition, most patients exhibited tracheal stenosis of grades II-III (50-99% of the lumen area). This could be attributable to the dyspnea patient selection criteria. The grade of stenosis is a predictive indicator since it represents the disease's extended course. Patients with high-grade stenosis are also at risk of reocclusion following surgery. When 50% of the airway lumen is occluded, dyspnea upon exercise is present. When 75% of the airway lumen is occluded, orthopnea occurs.\u003csup\u003e9\u003c/sup\u003e In adults, exertional dyspnea occurs when the airway lumen is 8 mm, whereas orthopnea occurs when the airway diameter is 5 mm.\u003csup\u003e9\u003c/sup\u003e All of our subjects exhibited severe airway stenosis resulting in dyspnea, necessitating immediate intervention as recommended.\u003c/p\u003e\u003cp\u003eIn our investigation, three causes of stenosis were identified: compression, invasion, and mixed type, with compression accounting for the majority (77.5%) of cases. Since there is no cartilage at this location, the esophageal tumor pushes against the posterior wall of the trachea. This variety has a more favorable prognosis and shorter treatment duration. In invasion cases, the tumor infiltrates the entire posterior wall and the airway lumen. This type had a greater risk of complications, particularly intraoperative and postoperative bleeding. Patients with invasive or mixed type endobronchial tumors were treated with a microdebrider and bipolar coagulation, which increased the duration of the procedure.\u003c/p\u003e\u003cp\u003eIntraoperatively, three patients had mild\u0026nbsp;hemorrhages, which\u0026nbsp;were\u0026nbsp;managed well by\u0026nbsp;bipolar surgery, all of whom had invasion. Two patients with narrowing segments near the carina had subcutaneous emphysema after tracheal incision due to low tracheostomy. There were no life-threatening complications, such as\u0026nbsp;pneumomediastinum or acute respiratory failure,\u0026nbsp;in our study, which is in concordance with previous studies.\u0026nbsp;\u003csup\u003e4,10,11\u003c/sup\u003e During the postoperative stay, the only complication\u0026nbsp;that occurred\u0026nbsp;was mucus plugging in\u0026nbsp;the\u0026nbsp;stent (30%), which was\u0026nbsp;resolved\u0026nbsp;by draining through the tracheostomy.\u0026nbsp;The\u0026nbsp;SpO2 level was restored to\u0026nbsp;a\u0026nbsp;normal value (SpO2 ≥ 95%) in all patients after the procedure,\u0026nbsp;indicating\u0026nbsp;the effectiveness of this procedure.\u003c/p\u003e\u003cp\u003eIn addition to the\u0026nbsp;abovementioned\u0026nbsp;advantages of silicone stents, the tracheostomy method employed in our\u0026nbsp;study\u0026nbsp;provided specific advantages. Initially, our strategy could aid patients in terms of rapid reventilation with readily available devices such as\u0026nbsp;microdebriders, bipolar\u0026nbsp;devices, and pince\u0026nbsp;Kochers. Our technique is simple and does not require rigid bronchoscopy with a dedicated rigid loading system, which is absent in the majority of nations with limited financial resources. Thus, our approach could be widely implemented in numerous centers, particularly in developing nations with a dearth of surgical instruments. In addition, our method established a\u0026nbsp;simpler\u0026nbsp;way to treat\u0026nbsp;dyspnea\u0026nbsp;by quickly dilating the stenosis and inserting an endobronchial tube via tracheostomy. After tracheostomy,\u0026nbsp;insertion of\u0026nbsp;an endobronchial tube, and\u0026nbsp;ventilation, the\u0026nbsp;patient’s\u0026nbsp;dyspnea improved significantly, allowing general anesthesia to be administered. This is practically essential since initial general anesthesia before rigid bronchoscopy is a contraindication in acute respiratory failure patients.\u003csup\u003e12\u003c/sup\u003e Thus, the objective\u0026nbsp;of deploying\u0026nbsp;silicone stents through rigid bronchoscopy through the mouth in our patients with respiratory distress was not achievable, making the tracheostomy technique more realistic. In addition, by tracheostomy, the location and severity of stenosis may be examined simply and precisely with an optic or even the naked eye. During the postoperative stay, problems such as mucus clogging and stent migration\u0026nbsp;can\u0026nbsp;be swiftly treated. This saved a great deal of time, as we only required an optic to examine through a tracheostomy, as opposed to a bronchoscopy or X-ray to diagnose in the case of stent deployment via the mouth.\u003c/p\u003e\u003cp\u003eDue to the need for a tracheostomy prior to stenting, one of the disadvantages of our approach was that the mean operative time (from tracheostomy to completion of stenting) was greater than\u0026nbsp;that\u0026nbsp;in previous investigations of endoscopic stenting.\u003csup\u003e2,4,7\u003c/sup\u003e This might theoretically increase the likelihood of problems. However, the complication rate was modest in our study, demonstrating that a longer operation time did not compromise the safety of our treatment. In addition, it is indisputable that tracheostomy increases the risk of bleeding, infection, and subcutaneous emphysema. We did not observe any of these problems during the postoperative stay in our study. This could be related to the use of prophylactic antibiotics and our postoperative care expertise. The only postoperative complication that occurred in our patients was mucus plugging, which can theoretically cause severe blockage and even death. However, owing to tracheostomy, this issue could be addressed securely even in the clinical ward. Additionally, the risk of mucus formation can be reduced by nebulizing sterile normal saline into the stent two to three times per day to maintain humidity.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe deployment of a silicone stent through a tracheostomy in patients with respiratory distress is simple, extremely successful, and able to normalize the spO2 level. Overall, our treatment is safe, cost-effective, and beneficial for the therapy of esophageal cancer with airway involvement. Our technique could be a viable option for other centers, particularly in countries with limited healthcare resources.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eVietnam National Cancer Hospital (VNCH); Ear Nose Throat (ENT)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study was approved by our research committee\u0026nbsp;of\u0026nbsp;Hanoi Medical University, Hanoi, Vietnam,\u0026nbsp;and Vietnam National Cancer Hospital, Hanoi, Vietnam.\u0026nbsp;Patient consent for the\u0026nbsp;publication of this study\u0026nbsp;was obtained.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Written informed consent was obtained from the patients for their anonymized information to be published in this article.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e All data generated or analyzed during this study are included in this published article.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not applicable (there is\u0026nbsp;no funding for this manuscript).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eDang Nguyen Van: Radiation oncologist, treated the patients and wrote the manuscript.\u003c/p\u003e\n\u003cp\u003eHung Nguyen Tien: Surgeon, treated the patients and wrote the manuscript.\u003c/p\u003e\n\u003cp\u003eDung Tran Trung: Surgeon, revised manuscript.\u003c/p\u003e\n\u003cp\u003eManh Pham Duy: Radiation oncologist, revised the manuscript.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e Not applicable\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834\u003c/li\u003e\n\u003cli\u003eXiong XF, Xu L, Fan LL, Cheng DY, Zheng BX. Long-term follow-up of self-expandable metallic stents in benign tracheobronchial stenosis: a retrospective study. BMC Pulm Med. 2019;19(1):33. Published 2019 Feb 8. doi:10.1186/s12890-019-0793-y\u003c/li\u003e\n\u003cli\u003eGuibert N, Saka H, Dutau H. Airway stenting: Technological advancements and its role in interventional pulmonology. Respirology. 2020;25(9):953-962. doi:10.1111/resp.13801\u003c/li\u003e\n\u003cli\u003ePeng Z, Xu S, Li H, Sun C, Fu M. Metallic expandable stents in the management of malignant tracheal stenosis due to esophageal cancer with lymph node metastasis. Oncology Letters. 2013;6(5):1461-1464. doi:10.3892/ol.2013.1588\u003c/li\u003e\n\u003cli\u003eDutau, H. (2013). Endobronchial Silicone Stents for Airway Management. In: Ernst, A., Herth, F. (eds) Principles and Practice of Interventional Pulmonology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4292-9_29 \u003c/li\u003e\n\u003cli\u003eGoh KJ, Lee P, Foo AZX, Tan EH, Ong HS, Hsu AAL. Characteristics and Outcomes of Airway Involvement in Esophageal Cancer. The Annals of Thoracic Surgery. 2021;112(3):912-920. doi:10.1016/j.athoracsur.2020.10.015\u003c/li\u003e\n\u003cli\u003eHamai Y, Hihara J, Emi M, Aoki Y, Miyata Y, Okada M. Airway Stenting for Malignant Respiratory Complications in Esophageal Cancer. Anticancer Research. 2012;32(5):1785-1790.\u003c/li\u003e\n\u003cli\u003eLemaire A, Burfeind WR, Toloza E, et al. Outcomes of tracheobronchial stents in patients with malignant airway disease. Ann Thorac Surg. 2005;80(2):434-437; discussion 437-438. doi:10.1016/j.athoracsur.2005.02.071\u003c/li\u003e\n\u003cli\u003eMostafa B, Mbarek C, Halafawi A. Tracheal Stenosis Diagnosis and Treatment.; 2021. ISBN: 10.13140/2.1.3006.9766\u003c/li\u003e\n\u003cli\u003eMa G, Yang R, Gu B, Wang D, Liao W, He X. Tracheal stent placement provides opportunity for subsequent anti-cancer therapy for cancer patients with malignant respiratory complications. Ann Palliat Med. 2021;10(2):1042-1049. doi:10.21037/apm-19-419\u003c/li\u003e\n\u003cli\u003eMiwa K, Matsuo T, Takamori S, et al. Temporary stenting for malignant tracheal stenosis due to esophageal cancer: a case report. Jpn J Clin Oncol. 2002;32(1):27-29. doi:10.1093/jjco/hyf004\u003c/li\u003e\n\u003cli\u003eSmith G, D\u0026apos;Cruz JR, Rondeau B, Goldman J. General Anesthesia for Surgeons. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 5, 2023.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eClinicopathological characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.17391304347827%\" colspan=\"2\" style=\"width: 73.3507%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.478260869565217%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.347826086956523%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"72.04861111111111%\" colspan=\"2\" style=\"width: 73.3507%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.95138888888889%\" colspan=\"2\" style=\"width: 26.4757%;\"\u003e\n \u003cp\u003e57,4\u0026plusmn; 9,0\u0026nbsp;(36-79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.270833333333336%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.95138888888889%\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.270833333333336%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEsophageal\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;tumor location\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.95138888888889%\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eCervical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eThoracic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.270833333333336%\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of narro\u003c/strong\u003e\u003cstrong\u003ewing segment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.95138888888889%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003e\u0026lt; 2 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003e\u0026ge; 2 cm and \u0026lt; 4 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003e\u0026ge; 4 cm and \u0026lt; 6 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e57,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003e\u0026ge; 6 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.270833333333336%\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.95138888888889%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e37,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e32,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.270833333333336%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eCause\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of stenosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.95138888888889%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eInvasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eCompression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e77,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.15576323987539%\" valign=\"top\" style=\"width: 31.1632%;\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.560747663551403%\" style=\"width: 13.8618%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.28348909657321%\" style=\"width: 12.0063%;\"\u003e\n \u003cp\u003e7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;complications\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.95498392282958%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.71061093247589%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.95498392282958%\" rowspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntraoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.71061093247589%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e87,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eSubcutaneous\u0026nbsp;emphysema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003ePneumomediastinum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eAcute\u0026nbsp;respiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.95498392282958%\" rowspan=\"8\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.71061093247589%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eMucus\u0026nbsp;plugging in stent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003ePneumomediastinum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eSubcutaneous\u0026nbsp;emphysema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eStent\u0026nbsp;migration\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.95498392282958%\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSpO\u003csub\u003e2\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.71061093247589%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge; 95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 95% and\u0026nbsp;\u0026ge; 90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e37,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 90% and \u0026ge; 85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.95498392282958%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;SpO2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.71061093247589%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge; 95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.167202572347268%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.219873150105705%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 12.5463%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.890063424947147%\" valign=\"top\" style=\"width: 13.6987%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endobronchial silicone, esophageal cancer, tracheal stenosis","lastPublishedDoi":"10.21203/rs.3.rs-4581280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4581280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePatients with advanced esophageal cancer often present with airway obstruction symptoms requiring emergency intervention. At the Vietnam National Cancer Hospital (VNCH), silicone stents, typically inserted via rigid bronchoscopy, were instead effectively placed through tracheostomy, yielding positive outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e From June 2019 to December 2023, 40 esophageal cancer patients with dyspnea due to tracheal blockage received airway silicone stenting by tracheostomy at the ENT Department at the VNCH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean age was 57.4± 9.0 years, ranging from 36 to 79 years. All patients were male (100%). Most patients had a 2-6 cm narrowing segment (87.5%). Most patients had airway stenosis due to compression (77.5%). Approximately one-third of all patients had grade I, II, or III airway stenosis, according to the Cotton-Myers classification. Intraoperatively, only 3 patients experienced hemorrhage (7.5%), which was controlled well by using bipolar coagulation forceps. Noneof the patients had serious complications, such as pneumomediastinum, actelasia, or acute respiratory failure. The only complication that occurred was mucus plugging inthe stent (30%), which was quickly resolved by draining through the tracheostomy. Most patients (92.5%) had SpO2 lower than 95% before surgery. After the procedure, all the patients had a normal SpO2 (SpO2 ≥ 95%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eSilicone stenting through tracheostomy in respiratory distress patients is safe, cost-effective, and valuable for the management of airway involvement in esophageal cancer patients. Our approach could be a good option for other centers to apply, especially in countries with healthcare resource constraints.\u003c/p\u003e","manuscriptTitle":"Endobronchial silicone stenting through tracheostomy is a life - saving technique for advanced esophageal cancer patients who present with tracheal stenosis: An institution’s experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 23:52:44","doi":"10.21203/rs.3.rs-4581280/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3c824f71-3bae-4279-bad5-e6ee7e20e1cc","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-05T11:00:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-15 23:52:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4581280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4581280","identity":"rs-4581280","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}