RESECTION WITH CURATIVE INTENT AFTER ENDOSCOPIC TREATMENT OF AIRWAY-OBSTRUCTION

Background. Endoscopic treatment of malignant central airway obstructi ons usually is done for palliation. The exact role of such a procedure as preparatory to operation remains controversial. Methods. From 1987 through 1996, 24 patients at our institution underwent tracheobronchi al pulmonary resection after preliminary endoscopic treatment. During the same period, 304 patients underwent 449 operative rigid bronchosco pies for airway obstructions, most involving the use of a neodymium:yt trium-aluminum-garnet laser. The indications for operation were squamo us cell carcinoma in 14 patients, bronchial gland tumors in 8 patients , and papillary thyroid cancer infiltrating the trachea in 2 patients. The total resection rate was 9.5% (5% for squamous cell carcinoma, 75 % for low-grade malignant bronchial tumors, and 75% for papillary thyr oid cancer). The median period between operative rigid bronchoscopy an d operation was 18 days. Results. No complications were observed after endoscopic treatment. There were two perioperative deaths (adult resp iratory distress syndrome after carinal resection and pulmonary emboli sm after pneumonectomy) and one major complication (poor postoperative pulmonary function after pneumonectomy). No anastomotic complications were observed in the tracheobronchoplastic procedures. Follow-up was possible in every patient but 1: 6 patients died at a median of 30.5 m onths after operation (range, 3 to 46 months), 2 patients are alive wi th disease, and the rest are alive without evidence of disease at a me dian of 21 months (range, 2 to 61 months). Conclusions. Most patients who require endoscopic therapy for malignant airway obstructions are n ot candidates for operative resection. Preliminary endoscopic relief o f obstruction can increase operability and improve surgical results in a highly selected group of patients. (C) 1998 by The Society of Thora cic Surgeons.