Bronchoscopic Management of Malignant Airway Obstruction

Abstract

Approximately one-third of patients with lung cancer will develop airway obstruction and many cancers lead to airway obstruction through metastases. The treatment of malignant airway obstruction is often a multimodality approach and is usually performed for palliation of symptoms in advanced lung cancer. Removal of airway obstruction is associated with improvement in symptoms, quality of life, and lung function. Patient selection should exclude patients with short life expectancy, limited symptoms, and an inability to visualize beyond the obstruction. This review outlines both the immediate and delayed bronchoscopic effect options for the removal of airway obstruction and preservation of airway patency with endobronchial stenting.

Updates on bronchoscopic management of airway disease

“…Due to the limited evidence in the literature, there is no well‐established guideline on the choice of stents in managing airway diseases . The general consensus is that uncovered metallic stents should not be used when there are other stent options available.…”

“…There are many adjuncts that have been employed for the endobronchial management of central airway obstruction. Some of them have demonstrated an immediate treatment effect by physically removing obstructing elements, while others have showed a delayed response …”

“…In interventional bronchoscopy, argon plasma coagulation (APC) has two main roles: to resect obstructing tumours/granulation tissue, and to control endobronchial bleeding . A beam of argon gas acts as a noncontact conduit for the electrocautery effect, which distinguishes APC from electrocautery.…”

“…The use of laser in bronchoscopy started in 1970s when the CO2 laser was used to treat various laryngeal disorders and endobronchial lesions. Bronchoscopic laser resection is a useful modality in the treatment of exophytic airway lesions . Thermal laser resection can be easily and safely combined with other methods of bronchoscopic treatment, including electrosurgery, stenting and brachytherapy.…”

Navigational Bronchoscopy for Early Lung Cancer: A Road to Therapy

“…At present, bronchoscopic-guided therapy for lung cancer is limited to debulking of malignant airway obstruction with a number of different techniques including electrocautery [ 62 ] and treatment of early in situ cancer for the airways [ 62 ]. However, given the access to cancer through novel bronchoscopic techniques, there is a growing interest in bronchoscopic-guided therapy for early lung cancer, such as brachytherapy microwave ablation and radiofrequency ablation.…”