How do we advance from daily struggles in malignant airway complications?
We appreciate Dr. Asif et al. for their interest in our article (1) and their insightful comments on our retrospective research regarding self-expanding metallic stent (SEMS) placement to relieve symptoms of malignant airway complications.
Firstly, Asif et al. rightly pointed out that results from studies with small sample sizes are often difficult to interpret with confidence. This is generally true. However, malignant airway complications represent an extremely urgent and life-threatening condition, where each case offers valuable clinical insight. The primary goal of our paper is to share the practical experience gained from managing these complex cases with our colleagues. Given the rarity of such complications, the number of cases was inevitably limited. While we could have opted to present the findings purely as a case series without statistical analysis, the consistency of the outcomes with our broader clinical experience encouraged us to publish the results. We believe that even with a relatively small sample size, the information provided may be of meaningful value to clinicians facing similar situations.
Secondly, Asif et al. pointed out that using a prospective framework involving standardized data collection will improve the quality of evidence. We agree with this as well.
In the case of malignant tracheal emergencies, the insertion of stents is typically an urgent procedure. Consequently, patient explanation and the procurement of informed consent are challenging. Furthermore, the limited number of cases leads to an inefficient return on the effort invested in data collection. We believe our article could serve as a foundation for future research.
Thirdly, Asif et al. pointed out that the efficacy of SEMS is challenging to ascertain due to the absence of a comparative study design. Noh et al. employed a historical control group to evaluate the efficacy of the novel SEMS insertion, which constituted a highly meaningful comparative study (2).
Given that the procedure or device has remained constant between the past and the present, conducting a comparative study has not been feasible in this investigation. In the present report, the majority of cases are emergent cases and the stenting intervention likely resulted in altered patient outcomes. A proportion of these patients were able to receive chemotherapy, while others were discharged or transferred to other medical facilities.
Lastly, a comparison of findings under uniform pathologic organ or histology results could potentially yield more accurate and actionable results. We deemed it unadvisable to reduce the number of cases by implementing standardized pathology findings since the number of cases was limited. The objective of this study was to assess the effectiveness of stents in cases of fatal carcinomas; it might be considered an inevitable limitation from practical data collection.
Accordingly, we agree that an increased sample size, prospective patient selection, and uniform pathology findings are desirable. In practice, circumstances analogous to the present article are infrequent; that is why we believe our article shows one clue and could push the clinician who struggles with the decision-making for a patient with a malignant airway complication, who should place a SEMS or not. Again, of course, higher-quality studies are needed to reach a definitive conclusion.
Acknowledgments
None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-25-52/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Matsumoto H, Sakairi Y, Kaiho T, et al. Self-expanding metallic stent placement for the palliation of malignant airway complications. Ann Palliat Med 2025;14:146-54. [Crossref] [PubMed]
- Noh JH, Gong EJ, Kim DH, et al. Efficacy and safety of a novel multisegmented fully covered self-expanding metal stent for malignant esophageal obstruction: a prospective pilot study with historical control. Surg Endosc 2025;39:942-51. [Crossref] [PubMed]
