Endoscopic laser treatment for tracheal obstruction

Abstract

OBJECTIVE: To evaluate the efficacy of endoscopic laser treatment (ELT)in patients with endoluminal tracheal obstruction. METHOD: A neodymium:yttrium aluminium, garnet (Nd:YAG) laser was used on 60 patients withsignificant (> 50%) tracheal stenosis. They were grouped as follows:primary tracheal malignancy (PTM n = 11), secondary tracheal malignancy(STM n = 27), benign tracheal tumours (BTT n = 4) and inflammatory trachealstenosis (ITS n = 18). Assessment was made clinically, endoscopically andusing ventilatory function tests (forced vital capacity (FVC) and peakexpiratory flow rate (PEFR)), before and after treatment. RESULTS: Therewas no treatment-related mortality. Peak expiratory flow rate improvedsignificantly overall and in the PTM, STM and ITS groups. There was nosignificant improvement in FVC overall or in any of the individual groups.Subjectively, 98% of the patients felt improved by ELT. The survival ineach group was: in the PTM group three patients are alive at 36, 49 and 74months while all other patients died, giving a mean survival of 8.8 +/- 2.6months. In the STM group the mean survival was 4.7 +/- 4.2 months. In theBTT group all patients are alive at the time of writing, two requireregular ELT. In the ITS group three patients died, two required Montgomerytracheostomy tubes for tracheomalacia, seven are receiving regular ELT andsix are disease free at the time of writing. CONCLUSION: We conclude thatELT is an effective method for the palliation of malignancy whichoccasionally gives long-term survival. It has a place in the management ofbenign tracheal neoplasia and inflammatory stenosis with a potential forcure in these cases.