[Interventional Bronchoscopies for the Treatment of 112 Cases with Complex Malignant Central Airway Diseases Involved in Bifurcation].

BACKGROUND: It is very difficult to deal with the comprehensive central airway diseases, especially the malignant airway obstruction. The aim of this study is to explore the clinical effects of multiple interventional bronchoscopies for the treatment of 112 cases with comprehensive malignant central airway diseases so as to evaluate the clinical applications of thermoablation and cryosurgery. METHODS: The 112 cases with malignant airway diseases retrospectively reviewed for bronchoscopic interventions performed in more than two lesions of carina and/or bifurcation. The age was from 22 to 90 years, which including 55 cases with squamous carcinoma (SQ), 16 adenocarcinoma (AD), 15 adenocystic carcinoma (ACC), 10 metastasis tumor (MT), 8 small cell lung carcinoma (SCLC) and 8 mixed carcinoma (MC). All bronchoscopic interventions such as argon plasma coagulation (APC), cryosurgery, electronic snare and stenting were performed under rigid bronchoscopy combined with electric bronchoscopy in general anesthesia. RESULTS: The 460 bronchoscopic procedures were successfully performed in 112 cases. Cryosurgery and APC were the most used in every group. Stent was more common in patients with MT, balloon dilation was more common in patients with ACC and AD. Electric snare and radioactive seeds implantation were frequently used in cases with SCLC. Trachea stricture is more severe in MT than that in others, while bronchus stricture is more severe than that of trachea in SQ and ACC group. Karnofsky performance score (KPS) is lower and shortness of breath score (SBS) is higher in MC, MT and SCLC group. Trachea and bronchus stricture is improved after comprehensive treatment in 5 groups except of mixed group. KPS increased and SS decreased significantly in 5 groups except of adenocarcinoma. In follow-up, the overall survival time (OS) is 15 months and median survival time is 10 months, especially OS is 28.4 months in ACC and 21.7 months in AD, 8.9 months in SCLC and 7.4 months in mixed group. CONCLUSIONS: APC combination with Cryosurgery and other bronchoscopic interventions are indicated for the treatment of complex or difficult airway diseases whether they are located in trachea or bronchus. It is a safe and rapid during procedure.

Bronchoscopic intervention as a main treatment for tracheobronchial adenoid cystic carcinoma.

BACKGROUND: Bronchial adenoid cystic carcinoma (ACC) is a rare disease with low malignancy and indolent progression. Airway obstruction caused by ACC can be resolved by endoscopic procedures. The efficacy of different techniques of bronchoscopic interventions for ACC has not been determined. MATERIAL AND METHODS: From November 2004 to March 2012, ACC patients, mainly treated with different techniques of bronchoscopic interventions in our hospital, were reviewed. RESULTS: The study included 37 ACC patients. Five patients (13.5%) with intra-luminal type underwent bronchoscopic therapies for a median of three times (range 1-6 times). Thirty-two patients (86.5%) with mixed type underwent bronchoscopic interventions for a median of 14 times (range 4-20 times). The dyspnea index was significantly improved after the first endoscopic procedure. The overall five- and ten-year survival rate was 85.9% and 45.9%, respectively, similar to surgery-dominant treatments. CONCLUSIONS: The present study demonstrates that different procedures of bronchoscopic interventions, as main treatments for ACC, are as effective as surgery-dominant treatment. More prospective and multicentric studies are required to confirm these favorable results, which may influence the therapeutic strategy for ACC in the future.

Bronchoscopic interventions combined with percutaneous modalities for the treatment of thyroid cancers with airway invasion.

This study was designed to explore the effectiveness and safety of the combination of bronchoscopic interventions and percutaneous modalities in treating thyroid cancers with airway invasion. A total of 13 patients, 5 men and 8 women, were retrospectively included into this study. All patients received bronchoscope treatment. Rigid bronchoscope was used to explore, ventilate, and dilate airway obstruction for temporary control in nine patients. Tumors were scavenged by CO2 cryosurgery combined with argon plasma coagulation (APC) in 11 patients. Four covered Z-type recoverable tracheal stents were selected for four patients. All patients had good airway control and palliative respiratory symptoms following treatments. Ten patients were further treated with CT guided (125)I seed permanent implantation, and one patient was treated with argon-helium cryoablation. The median local control was 22 months (10-55 months). The follow-up period ranged from 10 to 55 months (median 22 months). Three patients (23.1%) died of local recurrence, one of whom was due to airway obstruction and poor physical condition, two of whom with bleeding from relapsed tumor. One patient (7.7%) died of acute myocardial infraction. Nine patients (69.2%) were still alive according to the last follow-up. (125)I seed implantation and argon-helium cryoablation did not induce apparent complications. The combination of bronchoscopic interventions and percutaneous modalities might be a feasible and safe method for thyroid cancer patients with airway invasion.

[Electrocautery snare is combined with CO2 cryosurgery and argon plasma coagulation for the treatment of airway tumors and granulomas].

BACKGROUND: To observe the clinical effects and safety of endobronchial electrocautery snare combined with CO2 cryosurgery for the treatment of tracheobronchial obstructive lesions. METHODS: Seventy-seven patients with airway tumor or granuloma were retrospectively reviewed, including 70 malignant airway obstruction and 7 benign airway lesions, for the treatment of endobronchial electrocautery snare plus CO2 cryosurgery and argon plasma coagulation (APC). RESULTS: Eighty-five endobronchial snares were performed in 77 cases. 42.9% of the obstructive lesions were located in right bronchial orifice, 38.3% in main trachea 21.4% in left bronchial orifice. 89.7% of the malignant tumor was mixed type of lesions (endobronchial plus bronchial or external bronchial), only 10.3% was endobronchial. Obstructive stenosis was significant relieved after snare (80% before vs 20% after, P<0.01) in all patients. Karnofsky Performance Status (KPS) and shortbreath score were obviously improved after snare. There was no severe complications related to the procedures. CONCLUSIONS: Endobronchial electrocautery snare is an effective and safe approach for tracheobronchial obstructions with few complications.

Application of interventional bronchoscopic therapy in eight pediatric patients with malignant airway tumors.

AIMS AND BACKGROUND: Malignant airway tumors in children have rarely been reported. We evaluated the safety and therapeutic effects of interventional bronchoscopic therapy in 8 children with malignant airway tumors. METHODS AND STUDY DESIGN: We retrospectively analyzed 8 children with malignant airway tumors diagnosed by pathology, and evaluated their clinical features, chest computer tomography findings and bronchoscopic manifestations. RESULTS: Two of the 8 pediatric patients had high-grade malignancies (lymphoma and sarcoma) and the others all had low-grade malignancies, including 2 cases with mucoepidermoid carcinoma and 4 cases with inflammatory myofibroblastic tumor. Their ages ranged from 4 to 8 years (mean, 5.7 ± 0.9). There were no specific clinical manifestations in the children, and all of them presented with various respiratory symptoms, including cough and gasping associated with hemoptysis. Chest CT indicated round intra-airway neoplasms. Obstructive pulmonary atelectasis occurred in the main bronchus of 4 patients (3 cases of the left main bronchus and 1 case of the right intermedius bronchus). All children (1 case with local anesthesia and 7 cases with general anesthesia) underwent interventional bronchoscopic therapy, including argon plasma coagulation and CO 2 cryosurgery. The success rate for the rigid procedures was 100.0% (7/7), and the cure rate after 3 months was 85.7% (6/7). A part of the tumor remained in the lung of 1 patient with inflammatory myofibroblastic tumor after bronchoscopic treatment. One patient with local anesthesia died of suffocation caused by tumor consolidation during the bronchoscopic procedure. There were no recurrences in 6 patients during the follow-up period. One recurred patient was cured at 6 months. CONCLUSIONS: There are no specific manifestations in children with malignant airway tumors. Interventional bronchoscopic therapy seems to be safe and effective for those tumors under general anesthesia.

[Primary malignant airway neoplasms in 4 children].

OBJECTIVE: Primary airway neoplasms are extremely rare in the pediatric age group. This paper reports 4 children with primary airway neoplasms to explore the clinical manifestations, safety and efficacy of bronchoscopic interventions. METHOD: The data of pathology, photographic documentation and imaging studies were analyzed. RESULT: Of the 4 reported lesions, 2 were characterized by low-grade (2 with mucoepidermoid carcinoma) and 2 by high grade malignant (spindle cell carcinoma and malignant lymphoma). Onset of clinical manifestations occurred at the ages of 7 months to 7 years. All of them were initially misdiagnosed as bronchitis, asthma or atelectasis. The lesions located in trachea in 2 patients, in left bronchus of 1 patient and in right middle bronchus of 1 case. Atelectases occurred in bilateral bronchus where the lesions obstructed almost the entire lumen at the time of diagnosis. The diagnosis of airway masses depends upon maintaining a high index of suspicion, complemented by imaging and timely diagnostic endoscopy. The lesions were completely removed in 3/4 patients except 1 died during bronchoscopic procedures. CONCLUSION: The children with malignant airway neoplasms were presented with cough and wheezing without specific manifestations. Bronchoscopic interventions were effective in the treatment of non-operative cases. General anesthesia is strongly recommended for interventional bronchoscopy.

[Clinical analysis of interventional bronchoscopy for the treatment of malignant obstructive atelectasis].

BACKGROUND: Obstructive atelectasis is frequently accompanied by pulmonary infection and hypoxia. The key to treating this condition is by directly reopening the obstructive airway. The aim of the present study is to explore the safety and efficacy of interventional bronchoscopy for the treatment of malignant obstructive atelectasis. METHODS: A total of 120 cases with pathology-proved malignant obstructive atelectasis were retrospectively analyzed for the treatment of argon plasma coagulation and cryosurgery under bronchoscopy. Patients' age is between 5 and 90 years old. RESULTS: A total of 120 cases had 187 atelectasis originating from 98 lesions with primary airway tumors and 89 with metastases. The most common location of atelectasis was in the upper lobe in the primary group and in the single lung in the metastasis group. Although there was no significant difference in tumor debulging between the two groups, the reopening rate of atelectasis was lower in the primary group than that in the metastasis group. The Karnofsky physical score significantly increased, and shortbreath scale decreased after interventional bronchoscopy. Among the patients, 3/4 had hypoxemia and 3.4% had severe bleeding, which caused the death of 1 patient during a procedure. The mean survival time was 6 months, and the survival rate of 1 year was 27.1%. CONCLUSIONS: Bronchoscopy can rapidly and effectively debulge the airway tumor and reopen the atelectasis.

[Sealing of airway fistulas for metallic covered z-type stents].

BACKGROUND: Treating airway fistulas, including esophagorespiratory fistulas (ERFs), bronchopleural fistulas (BPFs), and tracheomediastinal fistulas (TMFs), is difficult. The aim of this study is to evaluate the safety and clinical efficacy of metallic covered Z-type stents (CZTS) for the treatment of airway fistulas through bronchoscopy or fluroscopy. METHODS: Thirty-eight patients with fistulas between the esophagus, mediastina, and airways (32 ERFs, 5 BPFs, and 1 TMF) were retrospectively reviewed after treatment with covered metallic esophageal and airway stents. The fistulas were caused by esophageal (n=26), bronchogenic (n=11), and thyroid (n=1) carcinomas. RESULTS: Forty-six fistulas were found in 38 patients. The fistula size ranged from 0.5 cm to 7.0 cm. Forty airway covered metal stents (24 Y-type, 8 L-type, and 8 I-type) and 24 esophageal metal stents were placed. Complete responses to the sealing effects of fistulas were noted in 4.3% of all the fistulas, 60.9% showed complete clinical responses, 23.9% showed partial responses, and 10.9% showed no response. An effectivity rate of 89.1% was observed, and the median survival duration of all patients was 5 months. CONCLUSIONS: The use of CZTS appears to be safe and feasible for the palliative treatment of ERFs, BPFs, and TMFs. Airway stent placement is recommended for patients with ERF. In the event that airway stents fail, esophageal stents should be given. Airway bifurcation stents were observed to be especially suitable for the sealing of fistulas near the trachea carina.

[Clinical application of video-assisted rigid bronchoscopy in the treatment of airway stenoses].

BACKGROUND AND OBJECTIVE: Treatment of critical airway stenoses remains a formidable challenge to surgeons and anesthesiologists. Suffocate is a leading cause of death if the patients with airway diseases were not treated properly. The purpose of this study is to explore the feasibility, safety and efficiency using video-assisted rigid bronchoscopes (VARB) in the treatment of central airway stenoses. METHODS: From August 27, 2007 to September 30, 2010, 194 patients (140 men and 54 women, mean age 57.5±1.3 years) with airway stenoses (145 with malignant and 49 with benign stenoses) were retrospectively reviewed underwent VARB treatment in our hospital. All the procedures were carried out under general anesthesia with high frequency jet ventilation. After the VARB was placed in the main trachea through the mouth, electric bronchoscope was combined to examine the lesions. Various methods for controlling the airway have been established to solve this problem, such as the electric loop, cryoprobe or argon plasma coagulation (APC) and stents. RESULTS: T325 procedures were accomplished in all the 194 cases. Every patients received 1.6 procedures of VARB. VARB occupied 21.3% (325/1,525) in all bronchoscopic procedures. Among the patients, there were 76 cases with primary airway tumor and 69 with secondary malignant tumor, 49 with benign airway stenoses. Karnofsky performance status (KPS) and short breathless index were obviously improved after the first treatment of VARB. Improvement of bronchial stenoses was superior to that of tracheal stenoses. The effect of electasis treatment is better in obstruction of main bronchus than that of segment bronchus. 26 airway stents were removed and 13 stents were successfully placed under VARB. CONCLUSIONS: VARB can be applied safely and effectively for the management of tracheobronchial stenoses. Quality of life was improved after the treatment of VARB.