The Annals of Thoracic Surgery, Vol 58, 1415-1418, Copyright © 1994 by The Society of Thoracic Surgeons
Neodymium:yttrium-aluminum-garnet laser for the treatment of tracheobronchial recurrences in esophageal carcinomas
M Fok, SY Law and J Wong
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Tracheobronchial recurrence occurred in 55 of 559 patients (9.8%) after
resection of their esophageal carcinomas and in 22 of 109 patients (20.2%)
after a bypass operation. The risk of airway recurrence increases if
residual disease is present in the mediastinum at resection. The median
survival of 55 patients diagnosed with tracheobronchial recurrence before
July 1988 was 3.7 weeks. After July 1988, there were 22 patients in whom
tracheobronchial recurrence developed, 19 of whom were treated by
neodymium:yttrium-aluminum-garnet laser under local anesthesia. Additional
external radiotherapy was offered to 8 patients who responded to laser
treatment and were in satisfactory condition. Four of these patients (21%)
had complete tumor regression. Partial regression occurred in 7 patients
(37%): 2 were treated by combined therapy and 5 by laser alone. Most
tolerated the laser treatment well, but the procedure was abandoned in 6
patients because of smoke inhalation. A tracheoesophageal fistula developed
in 2 patients. The median survival for the entire group was 7.4 weeks, with
3 long survivors who lived more than 1 year. The combined application of
laser and external radiotherapy is effective for the treatment of
tracheobronchial recurrences in patients with esophageal carcinoma.
