Nd

Abstract

Between April 1982 and March 1993, 1,585 patients with significant symptoms of malignant airway obstruction were treated with 2,253 tracheobronchial neodymium (Nd):YAG laser resections performed by the first author only: 1,274 (78%) patients had non-small cell lung cancers, 91 (6%) small cell lung cancers, 105 (7%) metastatic tumors, 61 (4%) rare malignant tumors, and 81 (5%) unclassifiable carcinomas. More than 90% of the Nd:YAG laser resections were performed with rigid bronchoscopy under general anesthesia (sedation plus analgesia with spontaneous ventilation). Almost all the cases (93%) showed immediate good results based on clinical, radiological, and endoscopic follow-up. Rapid regrowth of tumor is the major limitation; in our series the median time between the first and the second treatment was 100 days. Complications have been few to date: 18 hemorrhages, 6 pneumothoraxes, and 10 deaths. The mortality rate was 0.44%. Although laser resection is a palliative treatment, since 1983 we have treated 19 carcinomas in situ and none has recurred. This is also the case for some early endoluminal metastases. Finally, 17 patients with bronchogenic carcinoma that seemed inoperable did have surgery after laser therapy and another 21 underwent less extensive surgery than initially planned. Nd:YAG laser photoresection, in experienced hands, can be used safely and successfully to open airways obstructed by tumor growth while controlling bleeding. Its primary use is in the trachea and in the main bronchi.