Therapeutic bronchoscopy with immediate effect: Laser, electrocautery, argon plasma coagulation and stents

Date
2006
Authors
Bolliger C.T.
Sutedja T.G.
Strausz J.
Freitag L.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Minimally invasive diagnostic and therapeutic approaches in medicine have been applied for a more selective and tailored approach to reduce patients' morbidity and mortality. The efficacy of interventional pulmonology for palliation of patients with central airways obstruction has been established and its curative potential for intralesional treatment of early cancer has raised great interest in current screening programmes. This is due to the fact that surgical resection and systemic nodal dissection as the gold standard is relatively morbid and risky, especially when dealing with individuals with limited functional reserves due to smoking-related comorbidities, such as chronic obstructive pulmonary disease. Furthermore, such comorbidities have been proven to harbour early stage lesions of several millimetres in size without involvement of nodal disease that may be amenable to local bronchoscopic treatment. Therefore, the success of minimally invasive strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. Maximal preservation of quality of life is a prerequisite in successfully dealing with individuals at risk of harbouring asymptomatic early lung cancer, to prevent aggressive surgical diagnostic and therapeutic strategies since overdiagnosis remains an issue that is heavily debated. In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation and stenting are techniques that can provide immediate relief, in contrast to cryotherapy, brachytherapy and photodynamic therapy with delayed effects. With curative intent, intraluminal techniques that easily coagulate early stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease. Copyright © ERS Journals Ltd 2006.
Description
Keywords
airway obstruction, argon plasma coagulation, article, brachytherapy, bronchoscopy, cancer diagnosis, cancer size, cancer surgery, cauterization, chronic obstructive lung disease, comorbidity, cryotherapy, early cancer, human, laser surgery, lymph node dissection, palliative therapy, photodynamic therapy, postoperative complication, priority journal, quality of life, respiratory tract disease, smoking, stent, surgical risk, cancer staging, comparative study, electrocoagulation, equipment design, laser coagulation, lung tumor, pathology, review, trachea, trachea stenosis, treatment outcome, Airway Obstruction, Electrocoagulation, Equipment Design, Humans, Laser Coagulation, Laser Surgery, Lung Neoplasms, Neoplasm Staging, Palliative Care, Postoperative Complications, Stents, Trachea, Tracheal Stenosis, Treatment Outcome
Citation
European Respiratory Journal
27
6