HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Federico Venuta Erino A. Rendina Tiziano De Giacomo Giorgio F. Coloni Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Venuta, F. Articles by Coloni, G. F. Search for Related Content PubMed PubMed Citation Articles by Venuta, F. Articles by Coloni, G. F. Related Collections Lung - cancer

Ann Thorac Surg 2002;74:995-998
© 2002 The Society of Thoracic Surgeons

---

Original article: general thoracic

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

^a Department of Thoracic Surgery, University of Rome "La Sapienza," Rome, Italy

* Address reprint requests to Dr Venuta, Cattedra di Chirurgia Toracica, Policlinico Umberto I, University of Rome "La Sapienza," V.le del Policlinico, Rome 00100, Italy
e-mail: sofed{at}libero.it

Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

Background. Thirty percent of patients with lung cancer have airway obstruction requiring palliation. In addition, endoscopic resection may be considered before surgery or induction therapy to improve quality of life and functional status, and to allow better staging. It may also help to prevent infectious complications during induction chemotherapy.

Methods. Since 1993, 351 Nd:YAG laser resections were performed in 273 patients with lung cancer. The tumor involved the trachea in 36 patients, the carina in 28, the main bronchi in 154, the bronchus intermedius in 29, and the distal airway in 26. One hundred eight stents were placed. After the endoscopic treatment 36 patients were operated on (23 after induction chemotherapy) with 8 pneumonectomies (1 tracheal sleeve) and 28 lobectomies (15 bronchial sleeves). Spirometry, arterial blood gas analysis, and quality of life and performance status were recorded before and after laser treatment and after induction chemotherapy. Complications during chemotherapy, surgical morbidity and mortality, and survival were also recorded.

Results. Major complications during laser resection were bleeding (7 patients) and hypoxia (5 patients). Three patients died within 24 hours after the procedure. No complications were observed in the group of patients who subsequently underwent induction chemotherapy or surgery. One patient developed pneumonia during induction chemotherapy. The airway caliber improved in 89% of patients undergoing palliation only. In the group of patients undergoing induction chemotherapy and/or surgery, the performance status, quality of life, and functional measurements significantly improved after endoscopic treatment (FEV₁ from 1.4 ± 0.5 L/s to 2.2 ± 0.6 L/s). Three-year survival after induction chemotherapy and surgery, was 52%. Median survival after palliation alone was 12.1 months.

Conclusions. Nd:YAG laser resection is a safe and effective means of relieving airway obstruction. Before induction chemotherapy or surgery preliminary endoscopic palliation helps to improve evaluation and staging and contributes to reducing morbidity during chemotherapy without increasing surgical complications.

This article has been cited by other articles:

				C. S. Chin, V. Litle, J. Yun, T. Weiser, and S. J. Swanson Airway Stents Ann. Thorac. Surg., February 1, 2008; 85(2): S792 - S796. [Abstract] [Full Text] [PDF]

				M. E. Lund, R. Garland, and A. Ernst Airway Stenting: Applications and Practice Management Considerations Chest, February 1, 2007; 131(2): 579 - 587. [Abstract] [Full Text] [PDF]

				M. M. Wahidi, F. J. F. Herth, and A. Ernst State of the Art: Interventional Pulmonology Chest, January 1, 2007; 131(1): 261 - 274. [Abstract] [Full Text] [PDF]

				P. N. Chhajed, R. Eberhardt, H. Dienemann, A. Azzola, M. H. Brutsche, M. Tamm, and F. J.F. Herth Therapeutic bronchoscopy interventions before surgical resection of lung cancer. Ann. Thorac. Surg., May 1, 2006; 81(5): 1839 - 1843. [Abstract] [Full Text] [PDF]

				G. Shanmugam and K. Buchan Emergency resection of a carinal adenoma J R Soc Med, January 1, 2006; 99(1): 38 - 39. [Full Text] [PDF]

				G. Y. Jin, J. M. Lee, Y. C. Lee, Y. M. Han, and Y. S. Lim Primary and Secondary Lung Malignancies Treated with Percutaneous Radiofrequency Ablation: Evaluation with Follow-Up Helical CT Am. J. Roentgenol., October 1, 2004; 183(4): 1013 - 1020. [Abstract] [Full Text] [PDF]

				A. Ernst, D. Feller-Kopman, H. D. Becker, and A. C. Mehta Central Airway Obstruction Am. J. Respir. Crit. Care Med., June 15, 2004; 169(12): 1278 - 1297. [Abstract] [Full Text] [PDF]