Therapeutic bronchoscopy for malignant central airway obstruction: impact on quality of life and risk-benefit analysis

Bashour, Sami I.; Lazarus, Donald R.

doi:10.1097/mcp.0000000000000883

Cited by 8 publications

(4 citation statements)

References 39 publications

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“…Recent data also support the idea that therapeutic bronchoscopy may enable more definitive cancer treatment with further improving patient outcomes. Therefore, bronchoscopy can be safely used for therapeutic purposes in malignant central airway obstruction with effective outcomes (18) .…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic Cryotherapy in The Treatment of Endobronchial Typical Carcinoid

Fadaly¹,

Tawfek²,

Elsharawy³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Lung carcinoid tumors are low grade cancerous tumours that develop from neuroendocrine cells that have become more common recently. Endobronchial bronchoscopic cryotherapy has gained interest by cardiothoracic surgeons as an alternative to the surgical bronchotomy. Objective: The aim of the current study is to assess the efficacy of bronchoscopic cryotherapy in the treatment of endobronchial typical carcinoid. Patients and methods: A prospective controlled clinical trial included 30 patients presented with endobronchial typical carcinoid from the January 2021 to the August 2022. Patients were randomly divided into two equal groups. Group A included patients who had excision of the endobrochial mass using bronchscopic cryotherapy, and Group B included patients who had excision of the endobrochial mass using open surgical bronchotomy. Follow up of the patients was performed on regular basis clinically, radiologically and by bronchoscopic evaluation. Results: The Hospitalization period was shorter in Group A (6±2 hours), than in Group B (8±3 hours) showing a statistically significant difference. There was a high statistically significant difference between both groups regarding the postoperative scar presence (0 % in Group A vesurs 100% in Group B). Intraoperative and peri-operative data showed a non-significant difference (p>0.05) between both studied groups. Conclusion: Bronchoscopic cryotherapy is an efficient and safe procedure for the excision of endobronchial typical carcinoid.

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Section: Discussionmentioning

confidence: 99%

Bronchoscopic Cryotherapy in The Treatment of Endobronchial Typical Carcinoid

Fadaly¹,

Tawfek²,

Elsharawy³

et al. 2023

The Egyptian Journal of Hospital Medicine

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“…Among the various airway pathologies that may require stent placement, malignant airway obstruction is the most common [5,6]. Most commonly a result of primary lung cancer, airway obstruction can also develop from pulmonary metastases or intrathoracic complications from other malignancies, including lymphoma or breast, esophageal, colon, and renal cell carcinomas [1].…”

Section: Indications For Stent Placementmentioning

confidence: 99%

“…Airway obstruction generally consists of three main types: intrinsic (or endoluminal), extrinsic (or extraluminal), and mixed obstruction [5,6]. For intrinsic obstructions, which are most commonly a result of endoluminal tumor growth, therapeutic bronchoscopic interventions with the application of various ablative therapies can often provide adequate airway recanalization without stent placement [10][11][12].…”

Section: Indications For Stent Placementmentioning

confidence: 99%

Airway Stents in Interventional Pulmonology

Bashour,

Lazarus

2024

JoR

Self Cite

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Airway stents, first developed in the 1980s, have become fundamental in managing a multitude of airway pathologies and complications within the field of interventional pulmonology. The primary function of an airway stent is to re-establish airway patency and integrity when obstruction, stenosis, anastomotic dehiscence, or fistulae develop as a result of various malignant or benign conditions. Nevertheless, airway stents are foreign bodies that can result in complications. In this review article, we will discuss airway stents and their ongoing role in the management of several malignant and benign diseases. We will describe indications for airway stenting and review the elements that must be taken into consideration for optimal patient and stent selection. Given the prevalence of data regarding therapeutic bronchoscopy and airway stenting in malignant airway obstruction, much of the discussion in this review will focus on stent placement for that indication. We will also review the data as it pertains to safety, efficacy, and complications after stent placement, and conclude with a discussion of the future applications and research avenues related to airway stents.

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“…Similarly, Oviatt et al did not find a significant difference overall in HrQOL measured in 19 patients who underwent TB for MCAO despite 84% of patients maintaining airway patency ( 20 ). However, larger studies have demonstrated HrQOL improvement after TB for MCAO in both prospective and retrospective fashion ( 10 , 11 , 17 , 26 ). A retrospective study of 1,115 patients by Ost et al found that Greater baseline dyspnea was associated with improved HrQOL whereas lobar obstruction was associated with smaller improvements ( 10 ).…”

Section: Hrqolmentioning

confidence: 99%

Review of the clinical outcomes of therapeutic bronchoscopy for central airway obstruction

Ho¹,

Shah²,

Sagar³

2023

Mediastinum

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Central airway obstruction (CAO) is a debilitating condition with a significant impact on patient’s quality of life and risk of hospitalization from respiratory failure. The causes of CAO can be both benign and malignant. Benign CAO may be idiopathic or secondary to other disease processes (infection, intubation, tracheostomy, etc.). Malignant central airway obstruction (MCAO) may occur in patients with primary lung malignancy as well as metastasis from other malignancies including renal cell, colon, and breast. In a cohort review, MCAO was found in up to 13% of patients with newly diagnosed lung cancer. The obstruction may occur either due to endoluminal disease, extrinsic compression, or a combination of both. Several bronchoscopic tools are available to manage such obstruction. Practice patterns and tools used to relieve CAO vary between institutions and may depend on physician preference, patient characteristics, emergency nature of the procedure, and nature of the obstruction. To quantify the effect and added value of such interventions, it is crucial to understand the clinical impact these interventions have on patients. The clinical impact of therapeutic bronchoscopy (TB) must then be weighed against the potential complications to justify its value. Early studies of TB for CAO included patients with both malignant and benign etiologies. The study population’s heterogeneity makes it difficult to determine how TB affects clinical outcomes, as clinical outcomes are disease specific. The impact of TB for a MCAO may be different when compared to a benign CAO. Similarly, the clinical outcome of treating an idiopathic benign CAO may be different than that of a post tracheostomy airway obstruction. In this article, we will focus on the clinical outcomes of TB in MCAO. TB has been shown to have a clear impact on weaning from mechanical ventilation, dyspnea, health-related quality of life, survival and quality adjusted survival. The potential impact of TB on these outcomes should be weighed against the potential risk of complications. Understanding the factors associated with improved clinical outcomes will help physicians decide when and if TB is helpful. Future studies should focus on creating a decision analysis tool to further define decision thresholds.

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Therapeutic bronchoscopy for malignant central airway obstruction: impact on quality of life and risk-benefit analysis

Cited by 8 publications

References 39 publications

Bronchoscopic Cryotherapy in The Treatment of Endobronchial Typical Carcinoid

Bronchoscopic Cryotherapy in The Treatment of Endobronchial Typical Carcinoid

Airway Stents in Interventional Pulmonology

Review of the clinical outcomes of therapeutic bronchoscopy for central airway obstruction

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