Bronchoscopic management of central airway obstruction.

OBJECTIVES: Patients with central airway obstruction are critically ill, with impending suffocation. They are seen with diverse anatomic and functional deficits caused by both benign and malignant obstructions. Such cases were reviewed to examine the indications, techniques, and outcomes of an algorithm approach to bronchoscopic management.

METHODS: Between July 1992 and April 1996, 97 patients underwent bronchoscopic procedures for the management of central airway obstruction, and their cases were used for a retrospective review of the airway management.

RESULTS: There were 48 male and 49 female patients, aged 13 to 85 years. There were 48 benign and 49 malignant pathologic conditions that gave rise to 108 stenoses. These were treated with 199 endoscopic procedures with an average of 1.7 interventions per endoscopy, including mechanical core-out (62), dilation (135), laser ablation (44), placement of brachytherapy catheters (9), and stent placement (88). Diagnoses included lung cancer, primary tracheobronchial tumors, tumors metastatic to the airway or mediastinum, and a variety of benign obstructions. In the group of 97 patients there were 2 (2%) perioperative deaths and 34 (34%) late deaths, 29 in the malignant group and 5 in the benign group. Median survival was 7.6 months (range 1 week-31 months). There were 7 (7%) complications among the group of 97, 4 in the malignant group, and 3 in the benign group.

CONCLUSIONS: Endobronchial surgical techniques can be used safely and systematically for the relief of benign and malignant central airway obstructions; a diversity of approaches and interventions are required to produce and maintain palliation of airway symptoms.