To assess the utility of therapeutic bronchoscopy in the combined endoscopic and surgical management of malignant airway lesions to allow curative parenchyma sparing surgery.
All 74 consecutive patients (Switzerland and Germany) with non-small cell lung carcinoma undergoing an interventional bronchoscopic procedure (laser, argon plasma coagulation, electrocautery, stent insertion, mechanical debridement) followed by surgery with a curative intent were included. Indications for interventional bronchoscopy were endobronchial staging of lung cancer and symptomatic relief of central airway obstruction due to dyspnea and/or post obstructive pneumonia.
A single interventional bronchoscopic method was used in 27 (36%) patients and a combination of methods in 47 (64%) patients. There was a mean increase of 19% in the FVC after interventional bronchoscopy. Pneumonectomy was performed in 28 (38%) patients, sleeve upper lobectomy in 22 (30%) patients, upper bilobectomy in 16 (22%) patients, pneumonectomy with sleeve resection in two (3%) patients and lower bilobectomy in two (3%) patients. Following surgeries were performed in one patient each: sleeve middle lobectomy, sleeve lower lobectomy, carina resection and complex reconstruction and exploratory thoracotomy. Overall, parenchymal sparing surgery was performed in 45 (61%) patients. Furthermore, parenchyma sparing surgery was performed in 30 patients (41%) with lesions in the main bronchi. There was no mortality in the first 30 days following surgery.
Parenchyma sparing surgery could be performed in 61% patients with non-small cell carcinoma after therapeutic interventional bronchoscopy for malignant endobronchial obstruction.
The role of interventional bronchoscopy is well established and commonly associated with the palliative treatment of malignant central airway obstruction. The findings of our study show that interventional bronchoscopy has an important role in patients with malignant airway obstruction with potentially resectable lung cancer. Furthermore, therapeutic interventional bronchoscopy permits parenchyma sparing surgery in patients with lung cancer undergoing surgery with a curative intent.
Prashant Chhajed, None.