Complications of silicone airway stents in malignant and benign central airway stenosis: timing of complications and survival outcomes

BACKGROUND:
Silicone airway stents restore airway patency in central airway stenosis but may be complicated by migration, mucostasis, granulation tissue, and tumor overgrowth.


OBJECTIVE:
To compare complication profiles, timing of complications, and survival outcomes after silicone airway stent placement in malignant versus benign central airway stenosis.


DESIGN:
Retrospective comparative cohort study.


SETTING:
Single center, tertiary referral interventional bronchoscopy unit in Ankara, Türkiye.


PATIENTS AND METHODS:
Consecutive adults who underwent silicone airway stent placement by rigid bronchoscopy between September 2012 and July 2017 were reviewed and analyzed.


MAIN OUTCOME MEASURES:
Complication distribution by etiology, time to first complication, complication-free survival, and stent survival.


SAMPLE SIZE:
80 patients (59 malignant, 21 benign)


RESULTS:

Complications occurred in 48% of benign and 30% of malignant cases, with significant differences in complication profiles between groups (
P
=.003). Migration was the most frequent complication in benign stenosis, whereas stent-edge granulation predominated in malignant stenosis. In benign stenosis, median time to migration, mucostasis, and granulation was 17 days (interquartile range, 6–50), 135.5 days (63–140.5), and 206 days (103.8–354.5), respectively. In malignant stenosis, the corresponding times were 25.5 (21.3–29.8), 22 (21.3–22.0), and 89 days (57.5–181.5), while stent-margin tumor overgrowth was 105 days (78.5–174.5). Median complication-free survival was 500 days (95% CI, 353–857), with no significant difference between benign (701 days) and malignant (410 days) groups (
P
=.5138). Median stent survival was 578 days (95% CI, 351–956), also comparable between groups (351 vs 578 days;
P
=.9688).



CONCLUSIONS:
Silicone airway stenting is associated with distinct complication patterns and timing in benign and malignant central airway stenosis. These findings support structured post-stent bronchoscopic surveillance.


LIMITATIONS:
Retrospective single-center design, small benign subgroup, symptom-driven follow-up, and potential confounding and immortal-time bias in survival analyses.