Mitomycin C in the endoscopic treatment of tracheal stenosis: a prospective cohort study

Cataneo, Daniele Cristina; Ximenes, Aglaia Moreira Garcia; Cataneo, Antônio José Maria

doi:10.1590/S1806-37562017000000423

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ORIGINAL ARTICLE • J. bras. pneumol. 44 (06) • Nov-Dec 2018 • https://doi.org/10.1590/S1806-37562017000000423 copy

Mitomycin C in the endoscopic treatment of tracheal stenosis: a prospective cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the efficacy of mitomycin C (MMC) in the endoscopic treatment of tracheal stenosis.

Methods:

Patients with laryngotracheal, tracheal, or tracheobronchial stenosis were treated with dilation and topical MMC. The inclusion criteria were as follows: being ineligible for surgery (for medical reasons) at the time of evaluation; membranous stenosis responding well to dilation; and postoperative stenosis at the anastomosis site. Etiology of stenosis and indication for treatment with MMC, as well as site, length, and percentage of stenosis, together with presence of tracheostomy and duration of follow-up, were analyzed. The outcomes evaluated were symptom-free interval ≥ 12 months, number of dilations with topical application of MMC, and complications.

Results:

Twenty-two patients (15 men and 7 women) were treated between 2003 and 2010. Stenosis was due to endotracheal intubation in 15 patients and surgery in 8. Pure tracheal stenosis was encountered in 13 patients, subglottic stenosis was encountered in 4, tracheobronchial stenosis was encountered in 3, and complex stenosis was encountered in 2. The length of stenosis ranged from 0.5 cm to 2.5 cm, and the percentage of stenosis ranged from 40% to 100%. Nine patients had undergone tracheostomy and had a Montgomery T-tube in situ. Treatment was successful in 14 patients, who remained free of symptoms for at least 12 months. The number of topical applications of MMC ranged from 1 to 5, and complications included fungal infection, keloid scarring, granuloma, and mediastinal emphysema.

Conclusions:

MMC appears to be effective in the endoscopic treatment of tracheal stenosis.

Keywords:
Tracheal stenosis; Mitomycin; Endoscopy

Age, years/gender	Indication for MMC use	Site of stenosis	Percentage/length of stenosis^a	Reason for intubation	T-tube in situ	Outcome			Final outcome/follow-up period, months
Age, years/gender	Indication for MMC use	Site of stenosis	Percentage/length of stenosis^a	Reason for intubation	T-tube in situ	Free of symptoms for at least 12 months	Topical applications of MMC, n	Complications
28/F	Waiting for surgery	Subglottis	100%/2.5 cm	Diabetic coma	No	No	2		Tracheoplasty/12
45/M	Waiting for surgery	Trachea	90%/2.5 cm	Acute abdomen	No	No	5		Tracheoplasty/12
38/F	Waiting for surgery	Trachea	80%/2.5 cm	Stroke	No	No	2		Tracheoplasty/12
60/M	Waiting for surgery	Trachea	90%/1.0 cm	AMI	No	Yes	2		Resolution/12
23/M	Tetraplegia	Trachea	70%/1.0 cm	Trauma	Yes	Yes	1		Resolution/12
25/F^b	Membranous stenosis	Trachea	90%/1.0 cm	Trauma	Yes	No	1	Keloid scarring	Tracheoplasty/26
47/M	Neurological deficit	Trachea	40%/2.5 cm	Trauma	Yes	Yes	1	Fungal infection	Resolution/29
12/F	Membranous stenosis	Trachea	80%/0.5 cm	Trauma	No	Yes	5		Resolution/18
33/M	Neurological deficit	Trachea	90%/0.5 cm	Trauma	No	Yes	4		Resolution/14
48/M	Waiting for surgery	Trachea	80%/1.0 cm	AMI	No	No	4		Tracheoplasty/12
24/M	Complex stenosis	Larynx + trachea	40%/1.0 cm	Trauma	No	Yes	2		Resolution/24
19/F	Complex stenosis	Trachea + LMB	60%/2.5 cm	Trauma	Yes	Yes	4		Tracheal stenosis, resolution/stenosis of the LMB, carinal prosthesis/24
19/M	Waiting for surgery	Subglottis	90%/2.0 cm	Trauma	No	No	2		Tracheoplasty/12
29/M	Old stenosis	Trachea	40%/2.5 cm	Trauma	Yes	No	3		T-tube placement/12
26/M	Psychiatric disorder	Subglottis	80%/2.0 cm	Suicide attempt	Yes	Yes	1		Resolution/24

Age, years/gender	Site of stenosis	Percentage/length of stenosis^a	Surgical treatment	Montgomery T-tube in situ before surgery	Outcome			Final outcome/follow-up period, months
Age, years/gender	Site of stenosis	Percentage/length of stenosis^a	Surgical treatment	Montgomery T-tube in situ before surgery	Free of symptoms for at least 12 months	Topical applications of MMC, n	Complications
29/M	Subglottis	100%/0.5 cm	Laryngotracheoplasty	Yes	Yes	1	Restenosis	Resolution after MMC use/72
48/M	Trachea + bronchi	40%/1.5 cm	Tracheobronchoplasty	No	Yes	3		Resolution after MMC use/72
32/F	Trachea + bronchi	90%/0.5 cm	Tracheobronchoplasty	No	No	2	Mediastinal emphysema	Carinal prosthesis/12
50/F	Trachea	80%/1.0 cm	Tracheoplasty	No	Yes	3		Resolution after MMC use/72
22/M	Trachea + bronchi	80%/0.5 cm	Bronchial sleeve resection	No	Yes	4	Mediastinal emphysema	Resolution after MMC use/72
47/M	Trachea	90%/2.0 cm	Tracheoplasty	Yes	Yes	2		Resolution after MMC use/13
53/M	Trachea	50%/1.5 cm	Tracheoplasty	Yes	Yes	2		Resolution after MMC use/12
25/F^b	Trachea	90%/1.0 cm	Tracheoplasty	Yes	No	1	Granuloma	Stenosis of 50%/72

Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[1] Correspondence to:
Daniele Cristina Cataneo. Departamento de Cirurgia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, CEP 18618-687, Botucatu, SP, Brasil. Tel.: 55 14 3880-1529. Fax: 55 14 3880-1669. E-mail: dcataneo@fmb.unesp.br