Cryotherapy and electrocautery in the management of malignant endobronchial neoplasms

Abstract

Background Central airway obstruction is a problem facing all medical and surgical specialists caring for patients with chest diseases. Bronchoscopic cryotherapy (CRYO) and electrocautery (EC) are two different techniques used for the management of endobronchial lesions, and they have a role in palliative treatment of malignant central airway lesions. Aim The aim of the work was to compare between CRYO and EC in the management of malignant endobronchial neoplasms. Patients and methods A prospective study was conducted on 40 patients with malignant endobronchial mass who were selected for bronchoscopic CRYO and EC. Thirty-one men and nine women, with age range from 25 to 65years were included in this study. Bronchoscopic CRYO and EC were performed under local anesthesia using a flexible fiberoptic bronchoscope. Results CRYO and EC procedures provided significant improvement of dyspnea (P<0.01), cough (P<0.01), hemoptysis (P<0.01), performance, and quality of life status scales (P<0.01), chest radiograph, spirometry, arterial blood gas, and 100% successful reconstruction of the airway patency with complete succession in 63.64% in the EC group and 80% in the CRYO group and partial success in 36.36% in the EC group and 20% in the CRYO group with one (9.09%) case having developed complication in the form of pneumothorax in the EC group and no complication in the CRYO group; however, there were no significant difference between the two groups. Conclusion EC and CRYO are effective modalities of endobronchial debulking in the treatment of central airway obstruction associating endobronchial malignancy. They relieve symptoms, improve pulmonary function tests, arterial blood gas parameters, and quality of life in a significant way; moreover they are easy, safe, and cheap with minimal complications.

Keywords

• cryotherapy
• central airway obstruction
• electrocautery