Original article: general thoracic
Nd:YAG laser resection of lung cancer invading the airway as a bridge to surgery and palliative treatment

Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
https://doi.org/10.1016/S0003-4975(02)03874-2Get rights and content

Abstract

Background. Thirty percent of patients with lung cancer have airway obstruction requiring palliation. In addition, endoscopic resection may be considered before surgery or induction therapy to improve quality of life and functional status, and to allow better staging. It may also help to prevent infectious complications during induction chemotherapy.

Methods. Since 1993, 351 Nd:YAG laser resections were performed in 273 patients with lung cancer. The tumor involved the trachea in 36 patients, the carina in 28, the main bronchi in 154, the bronchus intermedius in 29, and the distal airway in 26. One hundred eight stents were placed. After the endoscopic treatment 36 patients were operated on (23 after induction chemotherapy) with 8 pneumonectomies (1 tracheal sleeve) and 28 lobectomies (15 bronchial sleeves). Spirometry, arterial blood gas analysis, and quality of life and performance status were recorded before and after laser treatment and after induction chemotherapy. Complications during chemotherapy, surgical morbidity and mortality, and survival were also recorded.

Results. Major complications during laser resection were bleeding (7 patients) and hypoxia (5 patients). Three patients died within 24 hours after the procedure. No complications were observed in the group of patients who subsequently underwent induction chemotherapy or surgery. One patient developed pneumonia during induction chemotherapy. The airway caliber improved in 89% of patients undergoing palliation only. In the group of patients undergoing induction chemotherapy and/or surgery, the performance status, quality of life, and functional measurements significantly improved after endoscopic treatment (FEV1 from 1.4 ± 0.5 L/s to 2.2 ± 0.6 L/s). Three-year survival after induction chemotherapy and surgery, was 52%. Median survival after palliation alone was 12.1 months.

Conclusions. Nd:YAG laser resection is a safe and effective means of relieving airway obstruction. Before induction chemotherapy or surgery preliminary endoscopic palliation helps to improve evaluation and staging and contributes to reducing morbidity during chemotherapy without increasing surgical complications.

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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