CARBON-DIOXIDE LASER BRONCHOSCOPY - A REVIEW OF ITS USE IN THE TREATMENT OF MALIGNANT TRACHEOBRONCHIAL TUMORS IN 142 PATIENTS

We report our experience over an 8-yr period, 1984-1991, of the use of the carbon dioxide (CO2) laser in the treatment of otherwise inoperab le malignant tracheobronchial lesions. In that period 142 patients (84 male, 58 female; median age 63 years) underwent 278 procedures. The t rachea was the site of treatment in 44 patients, the carina in nine, a main bronchus in 80 and a lobar bronchus in nine. All resections were performed under general anaesthesia via a rigid bronchoscope. Symptom atic relief was obtained in 103 of the 116 patients whose main complai nt was dyspnoea. Overall there was a mean improvement in forced expira tory volume in 1 s (FEV(1)) of 27%, in peak expiratory flow (PEF) of 2 2% and in forced vital capacity (FVC) of 7%. Most improvement in FEV(1 ) and PEF was obtained by the treatment of tracheal lesions. Three pat ients died within 24 h of surgery and 30 day mortality was 18%. At a m ean follow-up of 18.3 months the mean post-laser survival is 5 months. While the CO2 laser has limitations in the treatment of distal tumour s when compared to the neodymium/yttrium aluminium garnet (Nd:YAG) las er, there was no higher incidence of complications. We have found CO2 laser bronchoscopy to be an effective palliation of inoperable maligna nt tumours particularly of the trachea and main bronchi.