Nd:YAG laser resection of lung cancer invading the airway as a bridge to surgery and palliative treatment

Integration of interventional bronchoscopy in the management of lung cancer

“…Clinical studies have reported constant, immediate and significant improvement in symptoms, quality of life (assessed using the mean±SD Karnofsky index which increased from 77±4 to 91±4 [15]), gas exchange ( partial pressure of oxygen from 59±8 mmHg before intervention; to 78±6 mmHg after), and ventilatory parameters (improvement of 610 mL and 428 mL in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), respectively) [15][16][17]. In 92% of cases (n=1000), the bronchial diameter is restored, especially in cases of proximal tumours (trachea and main bronchi) [18].…”

“…The mortality rate directly associated with the laser procedure is low, reported to be <1% (0.8%, n=273 [15]; 0.7%, n=839 [19]; 0.67%, n=1000 [18]; and 0.99%, n=7000 [7]). Haemorrhages are treated using cold serum, adrenaline or terlipressin local administration, compression with the tube, or short pulses of less than 30 W. Severe haemoptysis only occurs in 1% of cases [10,15,19].…”

“…Haemorrhages are treated using cold serum, adrenaline or terlipressin local administration, compression with the tube, or short pulses of less than 30 W. Severe haemoptysis only occurs in 1% of cases [10,15,19]. There is a risk of ignition or airway fire, which is usually not serious and can be prevented by maintaining a low inspiratory oxygen fraction (<0.4) [17,19].…”

“…Stent implantation is indicated for the management of the extrinsic component of proximal stenoses and tracheo-oesophageal fistula [9,49,59], or as a supplement to treatment of intraluminal obstructions each time there is some degree of extrinsic component of bronchial wall destruction [13,15]. The SPOC (Role of a Silicone Prosthesis to Prevent Airway Obstruction Recurrence After Therapeutic Bronchoscopy in Lung Cancers) French prospective study was the first randomised trial designed to study the benefit of stent implantation after bronchoscopic removal of intraluminal tumours.…”

“…In cases where there has been prior debulking, it is sometimes possible to proceed with more conservative surgery than expected (61% of cases, n=74) or even to operate tumours initially thought to be inoperable [15,18,91,92]. Tumour size is, in fact, often revised downwards, with nodal status at times being distorted by the presence of post-obstructive pneumonia.…”