Abstract
Nd-YAG laser treatment via the fiberoptic bronchoscope has been performed in cases of malignant and benign airway tumors and stenotic inflammatory lesions. Bronchoscopic Nd-YAG laser treatment procedures were classified into two types ; (1) emergency life-saving procedures, and (2) planned debulking procedures. Each of these types was further classified into subtypes ; (a) with subsequent thoracotomy, and (b) without subsequent thoracotomy. In category (1a), 2 cases of adenoid cystic carcinoma causing marked tracheal stenosis were treated with Nd-YAG laser treatment as emergency procedures. The subsequent improvement in their condition simplified tracheoplasty, anesthesia and postoperative care. (1b) : In addition to one case each of adenoid cystic carcinoma and thyroid gland cancer which were successfully treated, 7 cases of severe tracheal stenosis caused by malignant tumors were treated in emergency procedures and appeared to obtain a short prolongation of survival. However, in a single squamous cell carcinoma case of survival for over a year was obtained. This procedure improved the patients' ventilation sufficiently so that radiotherapy can be performed. (2a) : In 8 malignant cases and 1 benign case debulking was performed before thoracotomy in order to decrease the area to be resected. However, in most cases it was not possible to significantly decrease the area to be resected. (2b) : 31 malignant inoperable cases were treated by debulking as a local adjuvant modality in combination with radiotherapy and chemotherapy. Evaluation of the effect of this procedure in terms of prognosis suggested that this treatment was indicated in about 50% of cases. In 12 cases of cicatricial stenotic lesions were also indicated which showed cicatrization without inflammation. This procedure may have potential as a single radical therapeutic modality in central type early stage lung cancer and benign tumors. Further improvement in instrumentation is required for this procedure. It is important to carefully evaluate the indications, remembering it is not indicated unless the lung parenchyma distal to the stenotic or obstructive lesion is viable.
