Clin Exp Otorhinolaryngol.  2015 Dec;8(4):396-401. 10.3342/ceo.2015.8.4.396.

Usefulness of Rigid Bronchoscopic Intervention Using Argon Plasma Coagulation for Central Airway Tumors

• Lee BR
• Oh IJ
• Lee HS
• Ban HJ
• Kim KS
• Kim YI
• Lim SC
• Kim YC
• Park YW
• Kwon YS

• KMID: 2128917
• DOI: http://doi.org/10.3342/ceo.2015.8.4.396

Abstract

OBJECTIVES
Argon plasma coagulation (APC) is a noncontact form of electrocautery that utilizes ionized argon as the electrical current. A rigid bronchoscopic use of APC for the management of central airway obstruction could be safe and rapidly effective. This study evaluated the usefulness of rigid bronchoscopy with APC for the management of central airway obstructions due to benign or malignant tumors.
METHODS
Twenty patients with obstructing central airway tumors were retrospectively reviewed from February 2008 to February 2013 at Chonnam National University Hospital. All patients received rigid bronchoscopic tumor removal under general anesthesia. APC was applied before and after tumor removal.
RESULTS
The median age of patients was 59 years (interquartile range [IQR], 51 to 67 years) and 70% were female. The causes of airway obstruction included malignancy (n=8) and benign tumor (n=12). Airway tumors comprised intraluminal lesions (n=11, 55%) and mixed intraluminal/extraluminal lesions (n=9, 45%). The median tumor size was 15 mm (IQR, 10 to 18 mm). The median degree of airway obstruction was significantly reduced after intervention (90% [IQR, 88% to 96%] vs. 10% [IQR, 0% to 20%], P<0.001). The median American Thoracic Society dyspnea grade (3 [IQR, 1 to 4] vs. 1 [IQR, 0 to 1], P<0.001) and forced expiratory volume in one second (1.03 L [IQR, 0.52 to 1.36 L] vs. 1.98 L [IQR, 1.57 to 2.64 L], P=0.004) were significantly improved after intervention. There were no procedure-related acute complications and deaths.
CONCLUSION
Rigid bronchoscopy with APC is an effective and safe procedure to alleviate central airway obstruction caused by tumors.

Keyword

Argon Plasma Coagulation; Bronchoscopy; Airway Obstruction

MeSH Terms

Airway Obstruction
Anesthesia, General
Argon Plasma Coagulation*
Argon*
Bronchoscopy
Dyspnea
Electrocoagulation
Female
Forced Expiratory Volume
Humans
Jeollanam-do
Retrospective Studies
Argon

Figure

• 

  Fig. 1 Treatment outcomes before and after rigid bronchoscopy. (A) Changes of ATS dyspnea grade. (B) Changes of FEV1 (L). (C) Changes of degree of stenosis (%). ATS, American Thoracic Society; FEV1, forced expiratory volume in one second.

• 

  Fig. 2 Chest computed tomography (CT) and bronchoscopy images of a 67-year-old female patient with primary endobronchial schwannoma completely removed by rigid bronchoscopic intervention with argon plasma coagulation. (A) Bronchoscopic finding showed a polypoid tumor with a smooth surface obstructing the lumen of the trachea. (B) Bronchoscopic finding about 2 months after intervention showed an opened trachea and a small residual nodule confirmed as a granulation tissue by bronchoscopic biopsy. (C) Chest CT before intervention showed a 1.6-cm-sized well defined oval tumor occupying trachea (arrow). (D) Chest CT about 2 months after intervention showed no recurrence in trachea.

• 

  Fig. 3 Chest computed tomography (CT) and bronchoscopy of a 52-year-old female patient with primary endobronchial schwannoma that was incompletely removed by rigid bronchoscopic intervention with argon plasma coagulation. (A) Chest CT showed a 3×2.7-cm lobulating mass in carina. (B) Bronchoscopic finding showed a large mass with a smooth surface near totally obstructing the lumen of the carina. (C) Bronchoscopic finding immediately after intervention showed opened main bronchi and a wide base of removed tumor.

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