Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer

Abstract

INTRODUCTION:Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer.METHODS:In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment.RESULTS:There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001).CONCLUSION:Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD.

Bronchoscopy and Thermal Ablation: A Review Article

“…Alternative uses for the laser have been proposed [10,11], including treatment of endobronchial tumors with curative intent. Unfortunately, these research projects are mostly limited by small samples and retrospective analyses.…”

Therapeutic bronchoscopy for malignant central airway obstruction: impact on quality of life and risk-benefit analysis

“…Although most of these studies were not designed to elucidate risk factors for complications of therapeutic bronchoscopy, one which did evaluated 464 patients undergoing laser treatment of malignant CAO. They found that older age, hypertension, and chronic obstructive pulmonary disease (COPD) were independent risk factors for complications of laser treatment [30]. Another group reviewing a series of 195 stent procedures performed in 172 patients found that the type of stent used was associated with certain complications, including infection for Aero stents and migration for Dumon silicone tube stents [37].…”

“…These studies have a great deal of heterogeneity in terms of the type and etiology of CAO, the techniques used to relieve it, and their definitions of complications [28]. With that said most studies of therapeutic bronchoscopy report low overall acute complication rates ranging from 0% to 18% with the majority of these characterized as mild [13,16,21,28–31]. Long-term complications are more common with airway stent procedures than other therapeutic techniques with some series reporting rates between 10% and 60% [32–35,36 ▪ ].…”