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RELIEF OF MALIGNANT AIRWAY OBSTRUCTION: A PROSPECTIVE AND RANDOMISED COMPARISON OF FIVE DIFFERENT ENDOSCOPIC TECHNIQUES

Department of Pneumology and Critical Care Medicine, Heidelberg, Germany

PURPOSE: 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.

METHODS: 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.

RESULTS: 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%.

CONCLUSION: The combination of APC and mechanical debridement seems the superior technique for airway recanalization in patients with malignant CAO.

CLINICAL IMPLICATIONS: APC and mechanical debridement seems the best technique in recanalisation of Malignant Airway Obstruction.

DISCLOSURE: Felix Herth, None.