[Palliative surgical indications in bronchial cancer]

Surgical palliation in bronchial carcinoma may be indicated for severe hemorrhage, putrid expectoration in large necrotising tumors, recurrent pleural effusion refractory to conservative treatment and loss of function of an entire lung due to bronchial and vascular obstruction. Alleviation of imminent asphyxia, dyspnea or malaise is the main purpose, whereas prolongation of survival remains uncertain. Palliative surgery is ranging from tumor pleurectomy to total pleuropneumonectomy. Depending on an individual situation this might be done as a primary indication or, if aforementioned complications must be anticipated, during elective surgery in advanced lung cancer instead of merely explorative thoracotomy. Bronchial obstruction with maintained lung perfusion alternatively is an excellent indication for endoscopic laser surgery, mostly combined with subsequent 192Ir afterloading therapy. Twenty-three cases of primary and secondary surgical palliation within a two-year period and 55 cases of laser/afterloading therapy in a three-year period are analyzed. Survival time is limited in the latter. Due to better general and functional state in the small surgical series in several patients not only relief from badly tolerated symptoms was achieved but also surprisingly long periods of survival with good quality of life in several cases. With proper selection operative mortality and morbidity of palliative surgery as well of laser therapy is of minor concern.