Salvage surgery of nonremovable metallic stent for adenoid cystic carcinoma and the subsequent difficulty of airway management

In 1999, a 60-year-old female diagnosed with tracheobronchial adenoid cystic carcinoma, was rejected due to the high risk reconstruction surgery of the carina. Our interventional radiological doctor implanted metallic stents for bilateral bronchial stenosis (right: Ultraflex, left: Spiral Z stent) to prevent endobronchial edematous asphyxia during radiation therapy. Radiotherapy showed that the tumor had decreased in size. The migrated right metallic stent was removed but the left one remained because it could not be removed. She had been unevenful for 3 years after the metallic stent implantation. In the 4th year, bronchoscopic balloon dilatation therapy had been performed for the produced dyspnea due to the exuberant granulation once every year for 4 years. The left lung had been destroyed by resuscitate pneumonia, thus we performed a pneumonectomy as salvage surgery using a cardiopulmonary bypass. The postpneumonectomy syndrome, dysphagia and dyspnea had confused her. Bronchoscopic balloon dilatation therapy had been continued for the right single airway stenosis every three months for 2 years. Eventually, she died of respiratory failure due to the recurrence of the disease after 12 years of treatment. We should require use of a silicone stent for the low grade malignancy of tracheobronchial airway stenosis. Eventual open thoracotomic removal should be done for management of the long-term complications of nonremovable metallic stents.