[Relieving the obstruction caused by malignant tracheobronchial tumors under flexible endoscopy]

We evaluate the feasibility and the efficiency of electrosurgery in the treatment of the symptomatic malignant tracheobronchial tree obstructions (MTTO) when it is used with flexible fiberoptic bronchoscopy without general anesthesia.

The aim of electrosurgery was to restore the permeability of the tracheobronchial tree to suppress symptoms. The operation lasted no more than 60 minutes, and a second operation was performed 8 days later if symptoms persisted. The patients received local anesthesia and light sedation (midazolm).

28 patients have been treated from june 1995 to june 1996 for following symptoms: dyspnea (22 cases), cough (1 case), dyspnea and cough (5 cases). All patients had malignant disease palliatively treated.

The protocol has failed in one case, needing general anesthesia. 27 patients have had one session, 6 a second one week later. After the first session, dyspnea was improved in 22/27 cases (81.5%) and cough in 5/6 cases (83%). After the second session, dyspnea was globally improved in 26/27 cases (96%), without change for cough.

Electrosurgery is a feasible and safe treatment which can implement immediately without general anesthesia, in MTTO. Its result are highly effective on dyspnea but less on cough, with reproducible effects and a well-tolerated procedure. Further investigations need to compare the different techniques.