Ann Thorac Surg 2008;85:631. doi:10.1016/j.athoracsur.2007.08.004
© 2008 The Society of Thoracic Surgeons
New Technology
Invited Commentary
Keith D. Mortman, MD
Section of Thoracic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331
(Email: mortmak{at}ccf.org).
Various methods of palliating endotracheal and endobronchial tumors are currently practiced. These include mechanical débridement, balloon dilatation, cautery, neodymium-doped yttrium aluminium garnet (Nd-YAG) laser, photodynamic therapy, and stent insertion, to name a few. In this article, Karakoca and colleagues [1] describe their use of a new "resector balloon" consisting of a balloon covered with polyurethane fibers in a hexagonal mesh pattern and mounted on a single lumen polyethylene tube. The device was used 38 times in 30 patients mostly for malignant endobronchial obstruction (one patient had a granulation tissue obstruction).
Because only 16% of patients with lung cancers present in the earliest stages [2], most lung cancer patients will have locally advanced or metastatic disease. A subset of these patients will have endobronchial tumors at presentation or the tumors will later develop and cause dyspnea, cough, wheezing, or hemoptysis. It is imperative for thoracic surgeons and interventional pulmonologists to aggressively treat malignant endobronchial obstruction to improve the quality of life for patients with advanced disease. The resector balloon described in the article is another tool that can be used to achieve this goal. Although this limited single-institution experience describes a reasonably safe approach—no significant bleeding, cartilage damage, perforation, or deaths were encountered—the main limitation was the balloons inability to destroy hard tumor, thus requiring the use of YAG laser or cryotherapy in 10 of 38 interventions. It cannot be determined from this early experience with limited data whether the resector balloon is superior to the other modalities previously mentioned, and no cost analysis is available for this prototype.
Perhaps future design improvements will allow the resector balloon to destroy firmer tumor, thus obviating the need for additional resources such as laser. Until that time however, thoracic surgeons should continue to use those resources currently available to them to palliate endobronchial tumors.
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References
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- Karakoca Y, Karaagac G, Aydemir C, Caner C. A new endoluminal resection technique and device: resector balloon Ann Thorac Surg 2008;85:628-631.[Abstract/Free Full Text]
- 14American Cancer Society Cancer Facts and Figureswww.cancer.org 2007Accessed September 7, 2007.
Related Article
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A New Endoluminal Resection Technique and Device: Resector Balloon
- Yalcin Karakoca, Guler Karaagac, Cuneyt Aydemir, and Cevdet Caner
Ann. Thorac. Surg. 2008 85: 628-631.
[Abstract]
[Full Text]
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