Central airway obstruction (CAO) is a common indication for therapeutic bronchoscopy. Different techniques are available; but they have never been compared directly in their efficacy and outcome.
Consecutive patients with malignant CAO due to endoluminal tumor growth were enrolled. If a patent airway distal to the obstruction could be verified, the patient was randomised to the following techniques: mechanical debridement (M), laser resection (L), Argon-Plasma Coagulation(APC), combined mechanical and laser resection (L-M) or mechanical and APC recanalization (APC-M). The results were controlled bronchoscopically after 6 weeks.
323 patients (109 females, 214 males, mean age 62,3 y) were examined until 250 patients (87 females, 163 males, mean age 65,3 y) could be included; 50 in every arm. The success rates without changing the technique were: M 76%, L 56%, APC 54 %, L-M 76 %, APC-M 96%. The mean procedure times were M 7,6 min., L 23,2 min., APC 13,5 min., L-M 13,5 min., APC-M 10,5 min. APC-M provided superior results (P 0,003); M was the fastest (p=0,02). The number of patients, which received a stent was not different (M 76%, L 84%, APC 74%, L-M 62 %, APC-M 52%). The 6 week survival rates were: M 96%, L 94%, APC 98 %, L-M 92 %, APC-M 96% p=0,2), none of the deaths were procedure related. Airway patency after 6 weeks in the patients without stenting was: M 0 %, L 60%, APC 72 %, L-M 72 %, APC-M 70%.
The combination of APC and mechanical debridement seems the superior technique for airway recanalization in patients with malignant CAO.
APC and mechanical debridement seems the best technique in recanalisation of Malignant Airway Obstruction.
Felix Herth, None.