Metallic ureteral stents in malignant ureteral obstruction: short-term results and radiological features predicting stent failure in patients with non-urological malignancies

Purpose

To provide short-term result of the metallic ureteral stent in patients with malignant ureteral obstruction and identify radiological findings predicting stent failure.

Materials and methods

The records of all patients with non-urological malignant diseases who have received metallic ureteral stents from July 2009 to March 2012 for ureteral obstruction were reviewed. Stent failure was detected by clinical symptoms and imaging studies. Survival analysis was used to estimate patency rates and factors predicting stent failure.

Results

A total of 74 patients with 130 attempts of stent insertion were included. A total of 113 (86.9 %) stents were inserted successfully and 103 (91.2 %) achieved primary patency. After excluding cases without sufficient imaging data, 94 stents were included in the survival analysis. The median functional duration of the 94 stents was 6.2 months (range 3–476 days). Obstruction in abdominal ureter (p = 0.0279) and lymphatic metastasis around ureter (p = 0.0398) were risk factors for stent failure. The median functional durations of the stents for abdominal and pelvic obstructions were 4.5 months (range 3–263 days) and 6.5 months (range 4–476 days), respectively. The median durations of the stents with and without lymphatic metastasis were 5.3 months (range 4–398 days) and 7.8 months (range 31–476 days), respectively.

Conclusion

Metallic ureteral stents are effective and safe in relieving ureteral obstructions resulting from non-urological malignancies, and abdominal ureteral obstruction and lymphatic metastasis around ureter were associated with shorter functional duration.     

Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases

Purpose

After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution.

Methods

This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20–80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision.

Results

Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction.

Conclusions

Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.     

Laparoscopic transabdominal transvesical repair of supratrigonal vesicovaginal fistula

Introduction and hypothesis

We investigated the clinical efficacy of early laparoscopic repair of supratrigonal vesicovaginal fistula.

Methods

Laparoscopic repair of vesicovaginal fistula was performed and retrospectively studied in 18 consecutive patients who had clear indications for iatrogenic supratrigonal vesicovaginal fistula following hysterectomy or obstetric trauma during delivery. All patients underwent laparoscopic surgery via the transabdominal transvesical route. Wide mobilization of the bladder and vaginal wall, complete excision of devitalized tissue, tension-free closure, omental interposition, and efficient postoperative bladder drainage provides dependable support for definitive closure of the path. Success was defined as the disappearance of the fistula.

Results

Average patient age was 36.7 years; none required open conversion. Mean operative time was 135  (range 75–175) min. Mean duration of bladder catheterization was 15 (range 14–16) days. All patients were cured at the first attempt, with no surgical reintervention or recurrence at a mean follow-up of 22.7 (range 3–45) months.

Conclusions

We believe that laparoscopic repair of supratrigonal vesicovaginal fistula is an excellent alternative to the traditional abdominal approach and provides excellent results.     

Is the robotic approach feasible for repair of iatrogenic injuries of the lower ureter?

Objectives

To analyze the robotic approach as treatment of iatrogenic ureteral injuries.

Methods

Medical records were reviewed for patients undergoing robotic-assisted laparoscopic ureteral reimplantation at the University of Missouri from 2009 to 2014. Patient charts were analyzed for demographics, prior abdominal surgeries, circumstances of injury, outcomes, and other relevant information.

Results

Nine patients met inclusion criteria. The average age was 44.6. Patients had an average of 4.3 abdominal surgeries. Injury occurred during hysterectomy (open, laparoscopic, or vaginal) in eight patients (88.9 %), five cases were laparoscopic, two utilized robotic assistance, and one injury occurred during uterosacral vault suspension. All cases were related to gynecological procedures. On average, ureteral injury was detected 17.2 days after the initial surgery and repaired 62.3 days after initial operation. The average surgical repair time was 295.9 min (range 168–498) with an average blood loss of 77.2 mL (range 20–150). Four patients required a psoas hitch, with one receiving both a psoas hitch and a Boari flap. Postoperatively, patients had an average hospital stay of 2.7 days. One patient had ileus for greater than 3 days, and another was readmitted within 30 days for pain control and antiemetics following stent removal. One patient underwent open reimplantation 3 years after original surgery for development of ureteral stricture. At follow-up, all patients had returned to baseline renal function.

Conclusions

Robotic approach is feasible and a safe option for distal iatrogenic ureteral injuries occurring during gynecological procedures. Prior abdominal surgery or delayed repair does not preclude a robotic approach.

     

Categorization of intraoperative ureteroscopy complications using modified Satava classification system

Objectives

To review our experience with ureteroscopy (URS) in the treatment of ureteral calculi and stratify intraoperative complications of URS according to the modified Satava classification system.

Patients and methods

We performed a retrospective analysis of 1,208 patients (672 males and 536 females), with a mean age of 43.1 years (range 1–78), who underwent ureteroscopic procedures for removal of ureteral stones. Intraoperative complications were recorded according to modified Satava classification system. Grade 1 complications included incidents without consequences for the patient; grade 2 complications, which are treated intraoperatively with endoscopic surgery (grade 2a) or required endoscopic re-treatment (grade 2b); and grade 3 complications included incidents requiring open or laparoscopic surgery.

Results

The stones were completely removed in 1,067 (88.3 %) patients after primary procedure by either simple extraction or after fragmentation. The overall incidence of intraoperative complications was 12.6 %. The most common complications were proximal stone migration (3.9 %), mucosal injury (2.8 %), bleeding (1.9 %), inability to reach stone (1.8 %), malfunctioning or breakage of instruments (0.8 %), ureteral perforation (0.8 %) and ureteral avulsion (0.16 %). According to modified Satava classification system, there were 4.5 % grade 1; 4.4 % grade 2a; 3.2 % grade 2b; and 0.57 % grade 3 complications.

Conclusion

We think that modified Satava classification is a quick and simple system for describing the severity of intraoperative URS complications and this grading system will facilitate a better comparison for the surgical outcomes obtained from different centers.     

Combined semirigid and flexible ureterorenoscopy via a large ureteral access sheath for kidney stones >2 cm: a bicentric prospective assessment

Purpose

The international guidelines on urolithiasis state that the percutaneous approach is superior for kidney stones ≥20 mm. Nevertheless, several groups have reported high stone-free rates (SFRs) with low morbidity for ureteroscopic treatment of calculi >15 mm. We hereby describe a new technique including the combined use of semirigid and flexible ureteroscopy via a large ureteral access sheath (UAS).

Methods

The proposed technique includes (a) preoperative ureteral stenting, (b) use of a large lumen UAS (14/16F, 35 cm), (c) use of a semirigid ureteroscope, (d) holmium laser lithotripsy, (e) passive and (f) active fragment extraction, and finally, the removal of caliceal stones (g) using a flexible scope. We conducted a prospective outcome analysis for 38 patients treated at two tertiary university centers.

Results

Perioperative data were as follows: median cumulative stone size 24.5 mm (20–60), median operating time 95 min (50–205), post-operative ureteral stenting (2–35 days) in 33 patients (86.8 %), Clavien complications 2 and 3 in 7.9 %, primary SFR 63.2 %, and overall computed tomography (CT) controlled SFR after 3 months 81.8 % (including staged procedures). No late complications were observed.

Conclusions

The combined use of semirigid ureteroscopy and an UAS further develops the endoscopic treatment of kidney stones. This is the first series of this kind that confirms high SFRs by CT. The approach has significant advantages: Superior irrigation and outflow enhance both vision and stone clearance, and multiple ureteral passages without putting the ureter at injury risk. These encouraging results make this modality an appealing alternative to percutaneous nephrolithotomy.     

Patellar dislocation due to iatrogenic quadriceps fibrosis: results of operative treatment in 54 cases

Objective

To evaluate the clinical and functional results of a surgical treatment of patellar dislocation whose etiology was iatrogenic quadriceps fibrosis in children.

Materials and methods

A prospective study was undertaken from February 2004 to December 2009. The study included 54 pediatric patients (56 knees) that had developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. There were 11 males (20.4 %) and 43 females (79.6 %). The patients’ mean age at surgery was 7 years, 9 months (range 6 years, 4 months to 12 years, 6 months). A complete history of each patient was recorded. The affected knees were evaluated preoperatively and postoperatively on the basis of the symptoms, signs, and roentgenographic findings. Patellar dislocation was classified according Bensahel’s criteria. All patients had a three-part surgical procedure that combined capsulorrhaphy, quadricepsplasty, and transfer of the vastus medialis oblique to the superior border of the patella.

Results

There has been no poor postsurgical result or recurrence so far; we have noted an ugly scar in nine knees (16.1 %), limitation of the knee flexion in five knees (8.9 %), and loss of extension of 5 °–20 ° in four knees (7.1 %). Overall, we attained excellent results in 39 knees (69.7 %), good results in 13 knees (23.2 %), and fair results in four knees (7.1 %).

Conclusion

In our cases of pediatric dislocation of the patella caused by iatrogenic quadriceps fibrosis, the introduced three-part surgical procedure has shown great success in restoring the realignment mechanism of the patella. The technique is simple, safe, and effective in skeletally immature children.     

Surgical management of multiple knee ligament injuries

Objectives

To summarize our experience and mid-term results of reconstruction with Iliotibial tract grafts for multiple ligament injuries.

Methods

Between July 1997 and December 2003, multiple ligament injuries of 15 patients were reconstructed with Iliotibial tract grafts in arthroscopy. There were 5 women and 10 men. The mean age at the time of the surgery was 30.5 years (range 25–43 years). There were 7 cases who were injured with combined ACL rupture and the PCL, and 8 cases were with disruption of both the ACL and the PCL, combined with damage of the medial collateral ligament.

Results

Fifteen patients were followed up for a mean of 7.5 years (range 6–12 years). The overall mean postoperative Lysholm score was 84.3 ± 5.7. At final IKDC qualification, 60.0 % of the knees were normal or nearly normal. The overall average Tegner activity score decreased significantly at the re-examination compared to the activity score before accident (3.6 ± 0.5 vs. 5.1 ± 0.6).

Conclusions

Reconstruction with Iliotibial tract grafts in arthroscopy was a reliable treatment for multiple ligament injuries.     

The treatment of type III acromioclavicular dislocations with a modified Cadenat procedure: surgical technique and mid-term results

Introduction

The treatment of type III acromioclavicular injuries is controversial. Both conservative and surgical approaches have been successful. Aim of the present study was to prospectively evaluate the results of the modified Cadenat procedure in subjects with type III acromioclavicular joint injuries.

Methods

Twenty-eight patients with acute type III acromioclavicular joint dislocations (mean age 31 years) were prospectively enrolled in the present study. The delay between the injury and the surgery varied between 4 and 19 days, with an average of 8.3 days. All patients were evaluated both preoperatively and postoperatively with radiographs and clinically with visual analog scale and Constant score. A modified Cadenat procedure was performed in all cases.

Results

Twenty-five patients were evaluated at an average follow-up of 72 months. One patient had a re-dislocation 3 years after surgery. At the last follow-up, average visual analog scale score of was 0.96 (range 0–3), while mean constant score was 94.32 (range 90–99) and 92 % of patient were very happy or happy with their functional result. Radiographs showed complete reduction in 22 patients and loss of reduction in two cases. No major complications were recorded.

Interpretation

This is the first clinical report on a modified Cadenat procedure. This operation has a reduced morbidity if compared to other techniques involving autologous grafts. Moreover, it yielded good functional results, with complete pain relief, and full strength recovery at mid-term follow-up. No major loss of reduction or recurrence of instability was observed.

Level of evidence

4, Case series.     

Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter

Purpose

To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients.

Methods

From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients.

Results

All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105 min (range, 90–135 min). The mean blood loss was 18 mL (range, 5–50 mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4–6 weeks postoperatively. The mean postoperative hospital stay was 7.3 days (range, 6–9 days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10 months, excellent improvement in the ureteral obstruction was observed.

Conclusions

We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed to confirm its benefits.     

Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction

Background

The use of self-expandable metal stents (SEMS) for the treatment of malignant colorectal obstruction is increasing. However, results of risk factors for its complications are inconsistent. This study aimed to examine the clinical effectiveness of the procedure as well as the complications and risk factors associated with the complications.

Methods

Medical records of patients with malignant colorectal obstruction who underwent endoscopic placement of covered or uncovered SEMS were reviewed retrospectively. The procedure was performed by two endoscopists with experience in pancreatobiliary endoscopy.

Results

A total of 152 patients were included (102 men; mean age, 70 ± 12.5 years). The procedure was performed for palliative management in 83 patients and performed as a bridge to surgery in 69 patients. There were 111 uncovered stents and 41 covered stents. The technical success rate was 100 % and the clinical success rate 94.1 %. Overall complications were observed in 49 patients (32.2 %) during the follow-up period (median, 98 days; interquartile range, 19–302 days). Obstruction (17.1 %), migration (7.9 %), perforation (5.2 %), bleeding (1.3 %), and tenesmus (0.7 %) were the causes of the complications. Stage IV disease, carcinomatosis peritonei, complete obstruction of the colon, palliative intention, and covered stents increased the complications based on the univariate analysis. Multivariate analysis revealed that complete obstruction of the colon and covered stents were significantly independent risk factors for complications. In the palliative group, Kaplan–Meier analysis showed significantly shorter median duration to the onset of complications in the covered stent group than in the uncovered stent group.

Conclusions

Although SEMS in patients with malignant colorectal obstruction is effective both as palliative therapy and as a bridge to surgery, one-third of patients experienced complications. Severity of obstruction and stent type can influence outcomes.     

Incidentally detected ureteral fibroepithelial polyps in children: is endoscopic treatment of them really necessary?

Objective

Fibroepithelial polyps (FEPs) are the most common benign lesions of the ureter. However, FEPs of the ureter accompanied by calculi are rare. In this study, we reviewed our experiences with five children having FEP associated with ureteral calculi to define more clearly this entity and its outcome following observation.

Materials and Methods

We identified five children who were intraoperatively found to have FEP associated with ureteral calculi during the period 2000–2008.

Results

The patients included four males and one female, and the average age of these patients was 6.4 years (range 4–9). The main symptoms were flank pain (five patients), hematuria (four patients), and dysuria (two patients). Radiographically, all patients showed complete ureteral obstruction due to distal ureter stone and hydronephrosis. Fibroepithelial polyps and stones were located left distal ureter in all children. These polyps were 1–2 cm, with a mean size of 1.5 cm. Stone sizes ranged from 5 to 13 mm (mean 8.8 mm). The stones were smashed into smaller fragments using a pneumatic lithotriptor, and the pieces were removed with forceps. After the lithotripsy, the polyps were grasped with biopsy forceps and punch biopsies were done. FEPs were diagnosed in all cases by postoperative histological examination. During the follow-up period of these patients, none of the FEPs displayed any growth or symptom.

Conclusions

Due to the potential complications during the ureteroscopic resection, our opinion is to observe the small FEPs without joint symptoms and hydronephrosis.     

Plasmadeponierte Kohlenstoffbeschichtung auf urologischen Verweilkathetern

Background

Any material placed in the urinary tract is susceptible to the formation of encrustations of crystalline bacterial biofilms. These biofilms cause severe complications in some cases. The strategies used so far for reduction of these complications by surface modifications of the implant material failed to show the expected results.

Patients and methods

In this study, we investigated amorphous carbon coatings (a-C:H) for their ability to effectively reduce or to repress the progressive formation of infection-enhancing crystalline biofilms as new functional surface coatings. In nine patients suffering for several years from stenting, a-C:H-coated ureteral stents were tested in treatment attempts. The current replacement intervals amounted to a mean of 77 days; the principle cause for early replacement was massive stent encrustations associated with symptomatic urinary tract infections.

Results

In total, 20 coated ureteral stents were tested spanning indwelling times between 3 and 4 months. No stent-related complications occurred. In all cases extraordinarily facile handling, less pain during replacement, and markedly increased tolerance were observed. Symptomatic urinary tract infections were reduced by more than 50%. The stents remained virtually free of encrustations.

Conclusion

a-C:H coatings are a novel strategy leading to an enhancement of long-term applicability of ureteral stents and catheters and to improved patient comfort.     

Induction of cold ischemia in patients with solitary kidney using retrograde intrarenal cooling: 2-year functional outcomes

Purpose

Renal hypothermia is commonly utilized during nephron sparing surgery to minimize ischemic tissue damage. We propose a method to induce renal hypothermia using continuous retrograde irrigation of iced saline via dual-lumen ureteral catheter. We will report results in an ex vivo porcine model followed by clinical outcomes in a series of patients with solitary kidney undergoing robotic-assisted laparoscopic partial nephrectomy (RALPN).

Materials and methods

First, we performed temperature measurements during retrograde renal cooling in a porcine model before investigating the technique in humans. In porcine experiments, renal cortical temperature measurements (n = 270) were recorded during retrograde infusion of ice-cold saline via a 10-Fr dual-lumen ureteral catheter placed in ureter. Subsequently, a series of patients (n = 10) undergoing RALPN with a solitary kidney had concomitant intra-operative retrograde renal cooling. A 10-Fr dual-lumen ureteral catheter was placed at initiation of anesthesia and cold saline initiated prior to renal artery clamping.

Results

Porcine cortical temperature reached the target temperature (≤20 °C) within an average of 203 s of retrograde irrigation. In the clinical series, patients’ mean preoperative creatinine was 1.16 mg/dL (GFR = 60). At a median follow-up of 10 months (range 1–27 months), postoperative creatinine was 1.50 mg/dL (GFR = 41.28). Average clamp time was 19.4 min. All patients had negative surgical margins.

Conclusions

Retrograde irrigation is a technically feasible method to induce cold ischemia, which may provide an additional protective effect of renal function in patients who have a solitary kidney undergoing surgery via a minimally invasive approach.     

Strahlenbelastung der Patienten bei der ureterorenoskopischen Steinentfernung

Background

We determined the intraoperative patient radiation exposure during ureteroscopic extraction of ureteral or renal stones.

Material and methods

The investigation was carried out in 215 patients who underwent ureteroscopy for ureteral or renal stone extraction. Radiation exposure was measured as dose-area product (DAP) within the X-ray beam. The effective abdominal dose was calculated using the specific conversion factor of 0.00323 mSv/µGy×m².

Results

Depending on the stone location (i.e. ureter or kidney), the type of ureteroscopy (i.e. semirigid or flexible) and type of stone removal (i.e. simple stone extraction or intracorporeal laser lithotripsy), the intraoperative patient radiation exposure (effective dose ED) ranged from 0.67 mSv (DAP 221.9 µGy×m²) to 2.23 mSv (DAP 744.2 µGy×m²).

Conclusion

Patient radiation exposure during ureteroscopic stone extraction is comparable to patient radiation exposure using plain film urography or low-dose non-contrast-enhanced computed tomography for diagnosis of urolithiasis.     

Risk factors for lower urinary tract injury at the time of hysterectomy for benign reasons

Objectives

To identify risk factors associated with lower urinary tract injury at the time of performing hysterectomy for benign indications.

Methods

We conducted a multi-center case–control study of women undergoing hysterectomy for benign disease. Cases were identified via ICD-9 codes for lower urinary tract injury at the time of hysterectomy from 2007 to 2011: controls were two subsequent hysterectomies following the index case in the same institution that did not have lower urinary tract injury. Logistic regression was used to perform univariate and multivariate comparisons between groups.

Results

At 7 centers, 135 cases and 270 controls were identified. Cases comprised 118 bladder injuries and 25 ureteral injuries; 8 women had both bladder and ureteral injury. Bladder injury was associated with a history of prior cesarean section OR 2.9 (95 % CI 1.7–5), surgery by a general obstetrician and gynecologist OR 2.4 (95 % CI 1.2–5.2), and total abdominal hysterectomy OR1.9 (95%CI 1.06–3.4). Ureteral injury was more likely among women who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) OR 10.4 (95%CI 2.3–46.6) and total abdominal hysterectomy (TAH) OR 4.7 (95 % CI 1.4–15.6).

Conclusion

Bladder injury at the time of benign hysterectomy is associated with a prior history of Cesarean section and TAH as well as surgery by generalist OB-GYN; ureteral injury is associated with LAVH and TAH.     

Video-assisted selective lateral neck dissection for papillary thyroid carcinoma

Background

The minimally invasive video-assisted thyroidectomy (MIVAT) for thyroid benign nodules and central neck dissection (CND) for papillary thyroid microcarcinoma (PTMC) have been applied, presently, we attempted to perform video-assisted selective lateral neck dissection (VASLND) for papillary thyroid carcinoma (PTC).

Methods

Twenty-six consecutive PTC patients with unilateral tumor (size <4.0 cm) and suspected lymph node metastasis at level III, IV, or IIa were included from March 2009 to January 2012.

Results

VASLND was successfully performed in all 26 PTC patients. The mean operative time was 46 min (range 26–75 min) on VASLND. No major complications occurred. Average postoperative hospital stay was 3.6 days (range 2–8 days). The mean number of removed nodes was 7.3 (range4–12) in central neck and 8.3 (range 3–21) in lateral compartment. Positive yield amounted to a mean value of 2.6 (range 0–5) and 3 (range 0–6), respectively. No persistent or recurrent disease was observed in any patient during a follow-up period. The cosmetic result was excellent.

Conclusions

Our initial experience demonstrates that VASLND is feasible and safe for selected PTCs, with superior appearance and less pain. Nevertheless, larger series and comparative studies with longer follow-up could be necessary to confirm its oncological effectiveness.     

Tracheal Stenting has Minimal Impact on Survival in Anaplastic Thyroid Carcinoma

Background

Anaplastic thyroid carcinoma (ATC) is the most aggressive form of thyroid cancer and it has an extremely poor prognosis. Rapid airway compromise is the main cause of death in patients with ATC.

Methods

The present study is based on a retrospective review of clinical data of patients with ATC treated over the last decade in a tertiary referral center.

Results

Between January 1998 and December 2010, 31 patients (13 males: 18 females) with a mean age of 74 years (range: 54–90 years) had a diagnosis of ATC made on fine-needle aspiration (n = 29) or biopsy (n = 2). Eight patients underwent total thyroidectomy and lymph node dissection, and five patients had attempted surgery but the procedure was abandoned because of inoperability. Airway compromise was clinically apparent in 11 patients. Five patients had tracheal stents inserted, with a median survival of 2 months (range: 1–36 months). In the whole cohort, 29 patients died of the disease, with a mean survival of 7 months (range: 1–36 months).

Conclusions

Survival of patients with undifferentiated thyroid cancer is severely compromised by airway obstruction. Palliation with tracheal stenting can rescue catastrophic airway obstruction but offers minimal survival benefit.