A REVIEW OF PALLIATIVE ENDOBRONCHIAL INTERVENTIONS PERFORMED IN PATIENTS WITH MALIGNANT AIRWAY OBSTRUCTION

Abstract

SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Malignant Airway Obstruction (MAO) results from various processes including direct invasion due to bronchogenic carcinoma, metastatic deposits with endobronchial obstructions, and extrinsic compression by mediastinal tumors and lymphadenopathies. Despite an overall poor prognosis, some patients may benefit from a palliative intervention with advanced endoluminal therapies. The ultimate goal is to restore airway patency, avoid hospital readmissions, and improve respiratory symptoms. Here, we present our experience in treating patients with MAO with endoluminal therapies including YAG laser, balloon tracho-bronchoplasties, and airway stenting. METHODS: From January 2018 to July 2020, we retrospectively reviewed 57 patients with inoperable malignant airway disease who underwent endoluminal airway interventions. Characteristics such as smoking history, type of procedure, necessity for re-intervention, and mortality within thirty days of intervention associated with the procedure were analyzed. Successful palliation was defined as decreased dyspnea and radiologic evidence of improved aeration of lung parenchyma. Categorical variables are descriptively summarized using percentages and continuous variables using mean and standard deviation. All statistical analyses were performed using SAS software, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS: 57 patients underwent a total of 121 endoluminal interventions for MAO. 51% were females, with a mean age ± std of 66±14.7. 57% were prior or active smokers. The most common malignancies were squamous cell carcinoma (28%) and metastatic disease (19%). Endobronchial tumor debulking was performed in 60% of the patients with yag laser therapy. Airway stenting was performed in 63% of patients and balloon dilatation was performed in 40% of patients. Planned re-intervention within 12 weeks from index procedure was performed in 65 % of the patients. 75% of the patients experienced significant clinical improvement. Mortality at thirty days was 2%. CONCLUSIONS: Palliative endobronchial intervention remains an important tool in patients with advanced non resectable MAO as it can provide relief of respiratory symptoms and improve quality of life with a low risk of thirty day mortality. CLINICAL IMPLICATIONS: Palliative endobronchial interventions may be considered in patients with inoperable MAO as it provides palliation, reducing dyspnea and recurrent post obstructive atelectasis. DISCLOSURES: No relevant relationships by Angel Porras, source=Web Response no disclosure on file for Fernando Safdie; No relevant relationships by Anita Singh, source=Web Response No relevant relationships by Francico Ujueta, source=Web Response