Endoscopic laser treatment for tracheal obstruction

To evaluate the efficacy of endoscopic laser treatment (ELT) in patients with endoluminal tracheal obstruction.

A neodymium: yttrium aluminium, garnet (Nd:YAG) laser was used on 60 patients with significant (> 50%) tracheal stenosis. They were grouped as follows: primary tracheal malignancy (PTM n = 11), secondary tracheal malignancy (STM n = 27), benign tracheal tumours (BTT n = 4) and inflammatory tracheal stenosis (ITS n = 18). Assessment was made clinically, endoscopically and using ventilatory function tests (forced vital capacity (FVC) and peak expiratory flow rate (PEFR)), before and after treatment.

There was no treatment-related mortality. Peak expiratory flow rate improved significantly overall and in the PTM, STM and ITS groups. There was no significant improvement in FVC overall or in any of the individual groups. Subjectively, 98% of the patients felt improved by ELT. The survival in each group was: in the PTM group three patients are alive at 36, 49 and 74 months while all other patients died, giving a mean survival of 8.8 +/- 2.6 months. In the STM group the mean survival was 4.7 +/- 4.2 months. In the BTT group all patients are alive at the time of writing, two require regular ELT. In the ITS group three patients died, two required Montgomery tracheostomy tubes for tracheomalacia, seven are receiving regular ELT and six are disease free at the time of writing.

We conclude that ELT is an effective method for the palliation of malignancy which occasionally gives long-term survival. It has a place in the management of benign tracheal neoplasia and inflammatory stenosis with a potential for cure in these cases.