Chest
Volume 90, Issue 2, August 1986, Pages 159-164
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Clinical Investigations
Bronchoscopic Cryotherapy for Airway Strictures Caused by Tumors

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This study reports an application of cryosurgery for the treatment of tracheobronchial tumors. Bronchoscopic cryotherapy can be applied in patients who are not candidates for other traditional therapy. The technique utilizes a nitrous oxide cryoprobe, introduced through a rigid bronchoscope. The principal feature of this probe is to be nonrigid. The cryodestruction is controlled by an impedance metric method. The study group consisted of 27 patients ranging in age from 39 to 88 years. The most frequent diagnosis was squamous cell carcinoma (14). For malignant tumors, the objective was obtained in 13 cases out of 21. Cryotherapy successfully destroyed five benign granulomas. Four or six days after cryotherapy, bronchial biopsy specimens usually showed a necrotic substance, and tumoral tissues were entirely destroyed. The time of survival is probably extended and the quality of life bettered. Most visible tumors are now reached with a flexible cryoprobe, inserted in a flexible bronchoscope.

Section snippets

Material and Methods

The endoscopic treatment was carried out using a cryoprobe that employs the Joule-Thomson effect (cooling of a gas upon sudden expansion from a high to a low pressure region).

This cryoprobe, with interchangeable tips, measures 55 cm in length and 3 mm in outside diameter. The principal feature of the probe is to be nonrigid, thus enabling one to reach tumors obstructing the main bronchus of the upper lobe. The entire probe is insulated except for the distal 1 cm. The cryoprobe is introduced

Results

Palliation was the most favorable outcome that we expected to achieve (Table 1). For malignant tumors of the bronchial tree, our objective was obtained in 13 cases out of 21: disappearance or important regression of the tumor permitting renewed or improved ventilation of a lobe (Figure 2, Figure 3, Figure 4) or a lung and interruption of hemoptysis.

We also managed to ablate five small benign granulomas without complications. Nevertheless, we had five technical failures: in one case, the probe

Complications

Two patients had a mild fever the same evening, but this may occur after any bronchial endoscopy. During cryotherapy, all patients were monitored by an electrocardiogram. Three of them showed a change in rhythm during the examination, but not coinciding with the time of cooling. A tachycardia often appears during bronchial endoscopy but it is not necessary to make electrocardiographic monitoring mandatory for this examination. Nevertheless, ECG monitoring revealed the reason for the death of an

Discussion

Cryotherapy in the bronchial tree is capable of inducing coagulation necrosis of tissue and destruction of tumors. All patients in this series with tumoral lesions were at an advanced stage of their illness; the data of this study do not show that survival has been extended, but the quality of life has certainly been improved with new ventilation of a lung or lobes and the cessation of hemoptysis. Five patients are still alive six months after cryotherapy; seven died from brain metastasis.

The

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Manuscript received May 1, 1985; revision accepted January 10.

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