Procedural safety and outcome of rigid bronchoscopy in malignant central airway obstruction

Malignant central airway obstruction (CAO) affects 20-30% of patients with primary lung cancer and is associated with poor prognosis without treatment. Therapeutic rigid bronchoscopy (RB) is an essential diagnostic and therapeutic tool in this group of patients. We aimed to assess the overall procedural outcomes and safety of RB for symptomatic malignant CAO at our institution.

Retrospective chart review included 57 patients with malignant CAO who underwent RB between March 2016 and June 2022.

Our cohort comprised 75.4% males with a median age of 60 years. Isolated right and left main bronchus involvement was observed in 50% and 41.7% of the patients, respectively, with 21.1% experiencing concurrent tracheal involvement. In our cohort, 80% had primary lung cancer, with 35.1% of these cases being squamous cell carcinoma. The re-canalization success rate was 98%, with no intraoperative or immediate postoperative mortality. More than half of the patients (54.4%) required airway stenting to maintain patency after re-canalization. Patients with tracheal involvement, non-intrinsic type of CAO, and right main bronchus involvement had a higher likelihood of requiring airway stenting. There were 24 cases with mild, self-limiting complications and 3 cases with severe procedure-related complications. The 30-day survival rate of our cohort was 91.6%.

RB is a safe and effective procedure in patients with malignant CAO. Long term prospective data from multiple centers in our region are anticipated to determine long-term safety and outcomes.