Procedure-free survival after therapeutic bronchoscopy in patients with central airway obstruction

Central airway obstruction (CAO) poses a significant risk of respiratory failure, often necessitating urgent intervention. Therapeutic bronchoscopy is a well-established method for palliation or definitive management of CAO. Although similar therapeutic maneuvers are employed for benign and malignant CAO, the long-term effectiveness and influencing factors are not fully described. This retrospective cohort study compares the clinical outcomes of therapeutic bronchoscopy for both.

This is a retrospective review of therapeutic bronchoscopies for initial CAO presentation at our tertiary center from January 1, 2019, to December 31, 2020. The primary outcome was procedure-free survival in both malignant and benign CAO cohorts. The impact of clinically relevant covariances on the primary outcome, reasons for follow-up bronchoscopies, and complications related to the procedures were also analyzed.

Ninety-six patients (66 % malignant, 34 % benign) underwent therapeutic bronchoscopy. The median procedure-free survival was 175 days in the benign cohort and 49 days in the malignant cohort. Airway prosthetics were associated with shorter procedure-free survival in both cohorts. Common reasons for follow-up bronchoscopies in both cohorts included disease recurrence or progression, stent complications, and surveillance. The median total number of procedures during the 2-year follow-up was 2 for both cohorts. Procedural complications were not common with more reported in the malignant cohort.

Therapeutic bronchoscopy effectively and safely treats both malignant and benign CAO, with longer-lasting effects observed in the benign group. Patients with airway prosthetics tend to require repeat procedures within a shorter timeframe in both cohorts.