Endoscopic lasersurgery in obstructive tracheal and bronchial tumors. An update

Endobronchial tracheal and bronchial obstructive tumors cause severe breathing impairment and may lead to death if the airway can not be maintained. Endoscopic laser surgery is one method to treat these patients. In this study the results of one tertiary care university hospital are analyzed. In the years 1987-1999, in Turku University Hospital, 102 patients were treated with 270 laser treatment sessions, 89 of them for a malignant and 13 for a benign disease. In the years 2000-2002 34 patients were treated in 65 laser treatment session, 21 for a malignant and 13 for a benign disease (Group B). Treatment was performed mostly with a combo CO2-Nd:YAG laser via a rigid bronchoscope, but also a CO2 laser and a fiberoptic Nd:YAG laser were used. The treatment was considered successful in 208 cases of 270 treatment sessions (77%). The most important single factor affecting the success of the therapy was the unfavourable location of the tumor (40 cases). In these cases the tumor was either located too distally in the bronchial tree, or the airway obstruction was found to be caused by extraluminal compression. There were two fatal complications (0.7%). Minor intraoperative bleeding occurred in 7.4% (20/270,) and intraoperative ventilation problems in 7.0% (19/270). In Group B there were one fatal complication (1.5%). Minor intraoperative bleeding occurred in 5 treatment session (7.7%). There were no complications when treating for benign disease. The one-year survival of the patients with malignant disease was 37.1% (33/89), the two-year survival 20.2% (18/89) and the five-year survival 9.0% (8/89). Laser treatment is an effective method in maintaining tracheobronchial ventilation as a palliative treatment modality. Serious complications are possible, but considering the fatal nature of the disease, they must be accepted. In cases of benign diseases, endobronchial laser treatment was very successful.