Neodymium: YAG laser therapy for obstructing tracheobronchial tumours

Thirty-nine patients with obstructing tracheobronchial tumours were treated with Neodymium: Yttrium-Aluminium-Garnet (Nd: YAG) laser photocoagulation over a period of six years. There were 29 males and ten females with a mean age of 44.3 years (range 6-79 years). Eight benign and 31 malignant lesions were treated with a total of 94 sessions of laser photocoagulation (mean 2.4 sessions). The anatomical distribution of lesions was as follows: larynx--six (three benign and three malignant); trachea--seven (one benign and six malignant), left main bronchus--ten (all malignant), right main bronchus--11 (one benign and ten malignant), and vocal cords--five (three benign and two malignant). There were 21 patients with squamous cell carcinoma, two adenocarcinomas, one adenoid cystic carcinoma, three cases of locally infiltrating tumours, four cases of carcinoid tumour and eight benign lesions. Twenty-one patients had the tracheostomy tube in place when treatment was started. Eighteen of the 21 patients with tracheostomies were weaned off the tube in a mean of 5.5 days from the start of the treatment. Lumen was restored in 31 (79.4%) patients. In the other eight (20.6%), lumen was achieved, but not sustained. Complications included bleeding in three cases which were managed conservatively, two cases of pneumothorax and four cases of bronchospasm. There were six deaths during follow-up (mean 21.2 months), but none attributable to the procedure. Laser photocoagulation offered effective treatment in the majority of patients with obstructing tracheobronchial tumours, with acceptable morbidity.