Endotracheal and bronchial laser surgery in the treatment of malign and benign lower airway obstructions.

Lower airway obstruction usually causes a remarkable reduction in the quality of life in cases of both benign and malignant tracheobronchial intraluminal tumor growth. Often this growth can also lead to premature death because of ventilation failure or, indirectly, because of fatal infections. In combination with external radiation therapy, laser surgery has become a standard means of treatment for these patients. From 1987-1999, 102 patients were treated with 270 laser treatment sessions (89 for malignant and 13 for benign diseases) at Turku University Hospital. Treatment was performed mostly with a combination of CO(2)-Nd:YAG laser via a rigid bronchoscope but also with a CO(2) laser and fiberoptic Nd:YAG laser. The treatment was considered successful in 208 cases of 270 treatment sessions (77%). The most important single factor affecting the success of the therapy was the unfavorable location of the tumor (40 cases). In these cases, the tumor was either located too distally in the bronchial tree, or the airway obstruction was found to be caused by extraluminal compression. There were two fatal complications (0.8%). Other complications affecting the quality of the procedure were minor intraoperative bleeding in 7.4% (20/270) and intraoperative ventilation problems in 7.0% (19/270). The 1-year survival of the patients with malignant disease was 37.1% (33/89), the 2-year survival 20.2% (18/89) and the 5-year survival 9.0% (8/89). Laser treatment is an effective method in maintaining tracheobronchial ventilation as a palliative treatment modality. Serious complications are possible, but considering the fatal nature of the disease, laser treatment can be recommended. In cases of benign diseases, endobronchial laser treatment was also very successful.