PALLIATIVE BRONCHOSCOPIC TREATMENT OF TUMOUR CENTRAL AIRWAYS STENOSIS

Abstract

Background. This article presents our three year experience with bronchoscopic management of central bronchial tumours stenosis.Methods. In the years 2000, 2001, and 2002, 52 patients (43 men, 9 women), aged 62.3 ± 10.8 years with central airway obstruction because of primary or secondary malignant tumours in 47 cases (90%) and benign diseases in 5 (10%) were treated. Topical anaesthesia with Lidocaine in all 52 patients where flexible bronchoscopes Olympus were applied was used. Additionally, Fentanyl or Diprivane were used in 25 patients where rigid bronchoscopy (Storz) was performed. Mechanical removal and electrocautery resection (Olympus) were used for tumour resection. In 2 patients Polyflex stent (Rüsch) was introduced into the trachea.Results. We treated 17 (33%) tumours in the trachea, 14 (27%) in the right, 15 (29%) in the left main bronchi and 6 (11%) in more peripheral bronchi. The combination of mechanical removal and electrocautery was applied in 32 (61%), mechanical removal alone in 4 (8%) and electrocautery alone in 16 (31%) of patients. Symptomatic relief was achieved in 41 (79%) patients. In 47 patients with malignant tumours bronchoscopic intervention was applied during the first diagnostic procedure 28 times (60%), after additional surgery, radiotherapy or chemotherapy 14 times (30%) and between additional therapeutic interventions 5 times (10%). The procedure had to be terminated in one patient due to hypoxemia. There was no immediate mortality.Conclusions. Mechanical desobstruction in combination with electrocautery through the flexible and/or rigid bronchoscopes and stent introduction in patients with central airways tumours are efficient and rather safe palliative procedures.

Keywords

• tumour stenosis
• mechanical removal
• electroresection
• stent introduction