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Ann Thorac Surg 2002;74:1928-1933
© 2002 The Society of Thoracic Surgeons

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Original article: general thoracic

Palliative management of malignant airway obstruction

^a Joseph Brown Whitehead Department of Surgery, Section of General Thoracic Surgery,, Emory University School of Medicine, Atlanta, Georgia, USA
^b Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA

* Address reprint requests to Dr Miller, Section of General Thoracic Surgery, The Emory Clinic, Inc, 1365 Clifton Rd, Atlanta GA 30322, USA.
e-mail: jmille6331{at}aol.com

Presented at the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.

BACKGROUND: Obstruction of the airway due to unresectable malignant disease is a frightening condition that portends a poor prognosis. Endobronchial treatment modalities were reviewed to determine the most effective management strategy.

METHODS: A 12-year retrospective review (1988 to 1999) of 121 consecutive patients with inoperable malignant airway obstruction (MAO) was performed. Sixty-five patients received high-dose-rate brachytherapy (HDR) alone, 32 received HDR plus neodymium:yttrium-aluminum garnet laser (YAG) therapy, 16 received YAG only, 4 patients were stented, and 4 received photodynamic therapy (PDT). Follow-up was obtained by chart review and contact.

RESULTS: Seventy-seven men and 44 women, median age 62 years (range 30 to 86 years), underwent 378 endobronchial procedures for relief of MAO. Good to excellent results were achieved in 77% (93/121) of patients. Seventy-two percent (23/32) of patients undergoing HDR plus YAG received a good to excellent result. All 8 patients receiving either stents or PDT had good to excellent palliation. There were no intraoperative deaths, but there were two in-hospital deaths. Complications occurred in 4% (5/121) of patients. Forty-four percent (53/121) of our patients were lost to follow-up. Mean survival was 6.7 months after the last treatment.

CONCLUSIONS: Temporary relief of inoperable MAO can be accomplished with a number of endobronchial treatments used either singularly or in combination. The majority of patients managed with HDR, YAG, or HDR plus YAG received good to excellent short-term palliation.

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