ENDOSCOPIC TREATMENT OF MALIGNANT AIRWAY OBSTRUCTIONS IN 2,008 PATIENTS

We report our 13-year experience with endoscopic treatment of malignan t obstructions of the air-way by Nd:YAG laser, stents, and intralumina l brachytherapy in 2,008 patients. We performed 2,610 laser resections in 1,838 patients, 66 high dose rate brachytherapies, and we placed 3 93 tracheobronchial silicone stents in 306 patients. We used the rigid bronchoscope in 96% of the laser procedures and in all cases requirin g stent placement; general anesthesia was given to 90% of these patien ts. Endobronchial radiotherapy was performed under local anesthesia. I n 93% of patients undergoing laser resection, we obtained an immediate patency of the airway with consequent improvement of quality of life. The median time between the first and second laser treatment was 102 days, being longer in the case of stent placement (when required) or i n association with brachytherapy. Even if endoscopic treatment should be considered only for palliation, laser vaporization could be curativ e in case of in situ carcinoma. Since 1983, we have treated 23 such le sions in 17 patients and up to now, none has recurred. Finally, endosc opic resection may allow a better assessment of the true extent of the tumor, shifting to surgery patients originally considered to have ino perable disease or allowing lung-sparing operations (21 and 18 patient s of our series, respectively). The total mortality rate was 0.4% (12 patients over 2,789 treatments; 2.710 Nd:YAG laser+151 stents without laser+37 brachytherapies without laser) in the first week after the pr ocedures, and was mainly related to cardiovascular problems and respir atory failure. In conclusion, endoscopic resection of lung malignancie s is rapid, effective, repeatable, and complementary to other treatmen ts; although it should be considered only palliative, laser resection could be curative in patients with in situ carcinomas and early cancer s. Laser, stents, and endoluminal brachytherapy should be available in all centers with major experience; a well-trained team is mandatory t o plan the most appropriate treatment and manage any possible complica tion.