THE MANAGEMENT OF TRACHEOBRONCHIAL OBSTRUCTION - A REVIEW OF ENDOSCOPIC TECHNIQUES

Tracheobronchial obstruction is a distressing cause of morbidity and m ortality in patients with benign and malignant disease. Resection offe rs curative treatment for a few, but for the majority of patients who are too frail for surgery, and for those benign and malignant cases wh ere the disease is too extensive for resection, there is a need for an effective method of palliation. We retrospectively reviewed the resul ts of a 9-year experience in 86 patients with major airways obstructio n (51 malignant and 35 benign) treated on one or more occasions using various endoscopic techniques. Nineteen patients presented as an emerg ency. Thirty-nine had received other forms of treatment beforehand inc luding external radiotherapy and laser resection (Nd:VAG). Treatment u ndertaken in our institution was: diathermy resection (36 patients), g old grain implantation (16 patients), bougienage (9 patients), cryothe rapy (2 patients), Montgomery T-tube and T-V stent (28 patients) and v aried endotracheal and endobronchial stents (40 patients). Twenty-two patients were treated with more than one modality at the first treatme nt session. Twenty-one patients required revision of their endobronchi al stents or T-tubes because of displacement or partial occlusion by m ucous accretions. There were no intraoperative deaths or complications and the average length of stay was 5 days (range: 2 to 14 days). Eigh ty-three patients reported immediate symptomatic relief. Objective imp rovement in lung function tests was demonstrated in patients whose con dition was less acute and preoperative measurements could be made. In the diathermy resection group there was an average improvement in forc ed expiratory volume in 1 s (FEV1) of 53.1% and in the forced vital ca pacity (FVC) of 20.6%. Median survival for patients with malignant str ictures was 5.2 months (range: 1 month to 8 years). Endoscopic managem ent of airways obstruction using the techniques we employ is safe, eff ective and leads to a lasting and worthwhile relief. It is feasible to use different modalities on the same patient on different occasions f or recurrent obstruction.