Tracheobronchial Polyflex stents for the management of benign refractory hypopharyngeal strictures

AIM:To describe a modified technique for placement of a tracheobronchial self-expanding plastic stent(SEPS) in patients with benign refractory hypopharyngeal strictures in order to improve dysphagia and allow stricture remodeling.METHODS:A case series of four consecutive patients with complex hypopharyngeal strictures after combinedtherapy for laryngeal cancer,previously submitted to multiple sessions of dilation without lasting improvement,is presented.All patients underwent placement of a small diameter and unflared tracheobronchial SEPS.Main outcome measurements were improvement of dysphagia and avoiding of repeated dilation.RESULTS:The modified introducer system allowed an easy and technically successful deployment of the tracheobronchial Polyflex stent through the stricture.All four patients developed complications related to stent placement.Two patients had stent migration(one proximal and one distal),two patients developed phanryngocutaneous fistulas and all patients with stents in situ for more than 8 wk had hyperplastic tissue growth at the upper end of the stent.Stricture recurrence was observed at 4 wk follow-up after stent removal in all patients CONCLUSION:Although technically feasible,placement of a tracheobronchial SEPS is associated with a high risk of complications.Small diameter stents must be kept in place for longer than 3 mo to allow adequate time for stricture remodeling.

Factors contributing to lymph node occult metastasis in supraglottic laryngeal carcinoma cT2-T4 N0M0 and metastasis predictive equation

Objective： To investigate factors that contribute to lymph node metastasis（LNM） from clinical cT2-T4 N0M0（cN0） supraglottic laryngeal carcinoma（SLC）, and to predict the risk of occult metastasis before surgery.Methods： A total of 121 patients who received surgery were retrospectively analyzed. Relevant factors regarding cervical LNM were analyzed. Multivariate analyses were conducted to predict the region where the metastasis occurred and prognosis. Results： The overall metastatic rate of c N0 SLC was 28.1%. Metastatic rates were 15.4%, 32.5% and 35.7% for T2, T3 and T4, respectively. Metastatic rates for SLC levels II, III and IV were 19.6%, 17.2% and 3.6%, respectively. A regression equation was formulated to predict the probability of metastasis in cN0 SLC as follows： Pn=e（–3.874＋0.749T3＋1.154T4＋1.935P1＋1.750P2）/[1＋e（–3.874＋0.749T3＋1.154T4＋1.935P1＋1.750P2）]. Approximately 0.2% of patients experienced LNM with no recurrence of laryngeal cancer. Comparison of the intergroup survival curves between patients with and without LNM indicated a statistically significant difference（P=0.029）.Conclusions： Cervical lymph node metastatic rates tended to increase in tandem with T stage in patients with LNM in cN0 SLC, and neck dissection is advised for these patients. Moreover, cervical LNM in cN0 SLC showed a sequential pattern and may be predicted.