Prognostic

Abstract

Background: Significant portions of central airway stenosis patients present with unresectable disease. Using bronchotherapeutic procedures to maintain a patent airway and improve clinical symptoms and quality of life is a well-known armamentarium technique. Aim: To assess the contribution of different physiological and pathological prognostic factors on the yield of endobronchial therapies (argon plasma coagulation (APC) and electrocautery) in patients with central airway obstruction whether derived from malignant or non-malignant etiology. Patients and methods: Twenty nine patients with central airway obstruction, 21 males and eight females, were recruited in the study. All the studied patients were categorized into malignant and non-malignant groups with different pathological varieties. Interventional bronchoscopic procedures were performed under general anesthesia. The flexible bronchoscope was either passed via an endotracheal tube or through the rigid bronchoscope. Collected data included patient demographics, evaluation of performance scale and quality of life status, evaluation of dyspnea, cough and hemoptysis scores before the interventional bronchoscopy and 1 day after the last session. Also the collected data included; length, size, localization and bronchoscopic appearance of the lesion. Duration of symptoms, duration of mechanical ventilation and the presence of collapse prior to the intervention were all recorded. Number of sessions and type of bronchoscopic modalities used were recorded. Spirometric pulmonary function tests were done before and 1 day after the last session. Results: Complete recanalization was achieved in (17/29) 58.6% of patients, while incomplete or partial recanalization was achieved in (12/29) 41.4% of patients. Using linear regression analysis of independent factors affecting patient outcome; it was found that the length of lesion followed by presence of collapse, duration of symptoms and lastly lesion localization whether localized or diffuse (P < 0.0005), (P < 0.011), (P < 0.02) and (P < 0.039) were the most independent factors affecting patient outcome. Conclusion: For favorable outcome, selection of patients with central airway obstructing lesions candidates for bronchoscopic argon plasma coagulation and/or electrocautery should rely on several factors including; age, duration of symptoms, performance scale, co-morbidities, pre-therapeutic FEV1%, presence of lung collapse, and length of the obstructing lesion, moreover its shape and localization.

Keywords

• Therapeutic bronchoscopy
• Central airway obstruction
• Argon plasma
• Electrocautery