Original article: general thoracicNd:YAG laser resection of lung cancer invading the airway as a bridge to surgery and palliative treatment
Section snippets
Patients and methods
Since 1993, 351 Nd:YAG laser resections were performed in 273 patients (181 males and 92 females; mean age 57 ± 14 years old) with lung cancer. In 257 patients the primary tumor directly involved the airway, whereas in 16 patients airway obstruction was related to endoluminal metastatic disease. The site of invasion and the number of treatments are reported in Table 1. Histology was epidermoid carcinoma in 111 patients (41%), adenocarcinoma in 120 patients (44%), large cell carcinoma in 12
Results
Major complications during laser resection were bleeding (7 patients) and hypoxia (5 patients). Bleeding was recorded as a complications when exceeded 200 mL; it was managed with adequate suctioning (usually two suction catheters are placed when this complication occurs), extensive coagulation with low power laser (we either retract the fiber or reduce the power to less than 30 W), instillation of epinephrine and compression by the tip of the rigid bronchoscope or small swabs. Hypoxia was
Comment
Direct infiltration or extrinsic compression of the central airway due to stage III A/B and stage IV lung cancer requires accurate clinical, technical and oncologic judgment. A significant reduction of airway caliber generally causes respiratory symptoms like dyspnoea, hemoptysis and recurrent infections; for this reason the first step should be restoration of a viable airway to treat symptoms and improve functional measurements; the appropriate treatment can be subsequently planned after
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