Over a 2-year period, 91 patients (68 men, 23 women) with a median age of 65 years (range, 28 to 85 years) were referred to our units for investigation and treatment of inoperable central airway stenoses. Eighty-nine patients suffered from advanced malignant disease, and 2 had external compression of a main bronchus caused by benign disease (1 aortic aneurysm, 1 complex deformity of thoracic spine). All patients were first examined by fiberoptic bronchoscopy under local anesthesia to assess the need for endobronchial therapy unless they presented with life-threatening obstructions. In 58 patients (40 men, 18 women) with a median age of 65 years (range, 35 to 85 years) mainly intraluminal tumor growth necessitated laser resection only, whereas the 2 patients with benign disorders were treated with stent insertion only. The remaining 31 patients (25 men, 6 women) with a median age of 67 years (range, 28 to 79 years) all had malignancies and formed our study group. They presented with predominantly extrinsic compression of the central airways that was managed by laser therapy combined with insertion of silicone stents. The diagnoses of these patients are listed in Table 1.
Laser and Stent Insertion Technique
After induction of general anesthesia and muscle relaxation, patients were intubated with the rigid Dumon-Harrell bronchoscope. Intraluminal tumor was resected with the Nd:YAG laser as described by Dumon et al and Cavaliere et al. For the resection of distal lesions, the fiberoptic bronchoscope was used through the rigid tube. Stenoses caused by extrinsic airway compression were dilated with the tip of the rigid bronchoscope or by balloon dilatation in case of increased bleeding tendency (percutaneous transluminal angioplasty balloon catheter, Cook, Denmark).
Table 1—Endoscopic Palliation for Tracheobronchial Stenoses (n = 31): Diagnoses
|Bronchogenic carcinoma (NSCLC)*|
|Squamous cell carcinoma||11|
|Metastatic pulmonary disease|
|Carcinoma of the colon||1|
|Carcinoma of the thyroid||1|
|Carcinoma of the tongue||1|
|Osteosarcoma of the femur||1|