SESSION TYPE: Therapeutic Bronchoscopy
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: To investigate the safety and effectiveness of microdebrider (MD) bronchoscopy in the management of central airway obstruction (CAO).
METHODS: After IRB approval, we reviewed cases of therapeutic bronchoscopies for CAO from two institutions (M.D. Anderson Cancer Center and Michael E. Debakey VA Medical Center, Houston) from August 2008 through February 2012, identifying those performed with MD. Demographic and clinical data were abstracted and analyzed.
RESULTS: We identified 46 cases. The median age was 64 years (range, 41 to 75), and 34 (74%) patients were male. CAO was secondary to both malignant (n=32, 70%) and benign (n=14, 30%) disease. Malignancies included: NSCLC (n=20), SCLC (n=2), carcinoid (n=1); melanoma (n=3), breast cancer (n=2), thyroid cancer (n=2), esophageal carcinoma (n=1), and tracheal carcinoma (n=1). Benign disease included: papillomas (n=8), granulation tissue (n=3), tracheal amyloid (n=1), tracheal schwannoma (n=1), and tracheal hamartoma (n=1). Obstruction was purely endoluminal in 29 cases (63%), and mixed in 17 cases (37%). The degree of obstruction was severe (>70%) in 24 cases (52%), moderate (>30 to 70%) in 16 cases (34%), and mild (<30%) in 6 cases (14%). Lesions were located in trachea (n=23), main stem bronchi (n=21), and bronchus intermedius (n=4), with some patients having more than one lesion. Lesions were involving the membranous posterior wall was in 28 cases (58%). After MD bronchoscopy, the residual obstruction was: none (n=31 cases; 68%), mild (n=14 cases; 30%), and moderate (n=1; 2%). Only two patients (4%) had complications: 1 pneumomediastinum which resolved spontaneously, and one patient’s self expandable stent was caught by the blades of the MD, requiring stent removal.
CONCLUSIONS: MD bronchoscopy is a safe and effective tool to manage CAO.
CLINICAL IMPLICATIONS: Although a common tool for head and neck specialists, the use of MD in bronchoscopy is relatively new and data is truly scant. To the best of our knowledge, this is the largest study, proving the MD to be safe and effective for both malignant and benign CAO.
DISCLOSURE: The following authors have nothing to disclose: Juan Iribarren, Carlos Jimenez, Donald Lazarus, Georgie Eapen, Rodolfo Morice, David Ost, Charlie Lan, Roberto Casal
No Product/Research Disclosure InformationBaylor College of Medicine, Houston, TX