THE MANAGEMENT OF TRACHEOBRONCHIAL OBSTRUCTION - A REVIEW OF ENDOSCOPIC TECHNIQUES

Tracheobronchial obstruction is a distressing cause of morbidity and mortality in patients with benign and malignant disease. Resection offers curative treatment for a few, but for the majority of patients who are too frail for surgery, and for those benign and malignant cases where the disease is too extensive for resection, there is a need for an effective method of palliation. We retrospectively reviewed the results of a 9-year experience in 86 patients with major airways obstruction (51 malignant and 35 benign) treated on one or more occasions using various endoscopic techniques. Nineteen patients presented as an emergency. Thirty-nine had received other forms of treatment beforehand including external radiotherapy and laser resection (Nd:VAG). Treatment undertaken in our institution was: diathermy resection (36 patients), gold grain implantation (16 patients), bougienage (9 patients), cryotherapy (2 patients), Montgomery T-tube and T-V stent (28 patients) and varied endotracheal and endobronchial stents (40 patients). Twenty-two patients were treated with more than one modality at the first treatment session. Twenty-one patients required revision of their endobronchial stents or T-tubes because of displacement or partial occlusion by mucous accretions. There were no intraoperative deaths or complications and the average length of stay was 5 days (range: 2 to 14 days). Eighty-three patients reported immediate symptomatic relief. Objective improvement in lung function tests was demonstrated in patients whose condition was less acute and preoperative measurements could be made. In the diathermy resection group there was an average improvement in forced expiratory volume in 1 s (FEV1) of 53.1% and in the forced vital capacity (FVC) of 20.6%. Median survival for patients with malignant strictures was 5.2 months (range: 1 month to 8 years). Endoscopic management of airways obstruction using the techniques we employ is safe, effective and leads to a lasting and worthwhile relief. It is feasible to use different modalities on the same patient on different occasions for recurrent obstruction.