Chest
Volume 91, Issue 2, February 1987, Pages 159-165
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Clinical Investigations
A Two-Year Experience with the Neodymium-YAG Laser in Endobronchial Obstruction

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In the first two years after the introduction of neodymium-yttrium-aluminum-garnet (Nd: YAG) laser therapy to our practice, 116 patients were treated 176 times. One hundred six patients (9L4 percent) were treated with the flexible fiberoptic bronchoscope. General anesthesia was used in 89.7 percent of treatments; there were four transient anesthetic complications. Three deaths from massive hemorrhage occurred in the first 59 treatments (first 30 patients). After laser power settings were reduced from 90 to 40 W, there were no further incidences of massive hemorrhage or death in the subsequent 117 treatments. The airway caliber was improved in 83.4 percent of treatments. The trachea, mainstem bronchi, and bronchus intermedius airway calibers were improved more often than those of the lobar bronchi. With lower laser power settings, Nd: YAG laser therapy is a safe and effective means of relieving airway obstruction. Thirty-six percent of patients were alive at one year. The median time to retreatment or death was 130 days.

Section snippets

Methods

All patients were referred for endoscopic management and palliation of significant symptomatic airway obstruction due to a malignant or benign process. Our intent was to accept and attempt laser resection on all patients referred for palliation. On the basis of initial clinical experience, we expected to develop guidelines for patient selection and treatment technique. In each case, conventional treatment with surgery, radiation, and chemotherapy had failed or the patient was considered

Results

One hundred sixteen patients received 176 Nd:YAG laser treatments from March 25, 1982, through March 24, 1984. Patients ranged in age from six months to 84 years, and the median age was 60 years. The 78 male (67 percent) and 38 female (33 percent) patients in the treatment group had nine benign lesions and 107 malignant lesions. Seventy-one patients had bronchogenic carcinoma. Of the 71 carcinomas, 65 (91.6 percent) were stage III, 1 (1.4 percent) was stage II, and 5 (7.0 percent) were stage I.

Discussion

At the time we began using the Nd:YAG laser for endobronchial resection of end-stage malignant tumors, there were no established criteria for patient selection, laser power settings, anesthetic techniques, or bronchoscope selection. At first, we attempted to treat any patient referred to us with malignant airway obstruction in whom all other reasonable methods of treatment had failed. Our initial criteria, established after 22 cases, were that the tumor should be endobronchial, that it should

References (26)

  • JF Dumon

    Fiber laser photoirradiation of tracheobronchial lesions

    WAB Newslett

    (1981)
  • MR Hetzel et al.

    Laser treatment for carcinoma of the bronchus

    Br Med J [Clin Res]

    (1983)
  • K Oho et al.

    Indications for endoscopic Nd-YAG laser surgery in the trachea and bronchus

    Endoscopy

    (1983)
  • Cited by (0)

    Manuscript received June 9; revision accepted August 20.

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