Clinical Study of Bronchoscopic Findings in a Process of Surgical Treatment of Lung Cancer

Abstract

Bronchofiberscopic findings observed during the course of case of lung cancer undergoing treatment usually can be devided into three periods, i.e. before, during and after operation. The primary purpose of preoperative bronchoscopic examination is mainly to obtain specimens to establish a histological diagnosis. Also evaluation of the clinical stage and concerning the indications and/or operative procedure is made on the basis of this examination. The accuracy of selection of preoperative method based on the endoscopic examination is approximately 92.6% in cases of primarily mucosal type lung cancer and 84.4% in primarily submucosal type. Bronchoscopic examination during operation is usually performed to decide on the extent of resection in cases of tracheo- or bronchoplasty. In rare cases it can be used for removing a foreign body which has dropped and blocked contralateral bronchus, liken the pointed tip of a polypoid squamous cell carcinoma with necrotic tissue which was removed surgically. Postoperative bronchoscopic examination is mainly performed for the purpose of bronchial toilet. Approximately 86.9% of thoracic surgery cases received bronchial toilet with 4 days after surgery. According to the operative procedure and the lobes resected, several types and degree of deformation of the residual bronchus can be observed most predominantly in cases of left upper lobectomy. Sometimes bronchial stenosis occurs due to deformation and protrusion. Tumor reccurence generally resembles primarily submucosal type of lung cancer. The findings of granulation around a suture or surgical stump can mimic a nodular type tumor. It can be difficult to point out small bronchial fistulae endoscopically. The risk of the occurrance of large bronchial fistulae can be predicted by the method of Fluorescein assisted endoscopic imaging. By this method the vasculature and possible ischemic changes in the mucosa around the surgical stump can be clearly defected in these cases. Postoperative bronchoscopic examination in lung cancer patients for follow-up is as important as chest X-ray examinations, and it provides much information which can not be obtained from the latter.