J Korean Med Sci.  2023 Aug;38(32):e244. 10.3346/jkms.2023.38.e244.

Clinical Outcomes of Bronchoscopic Cryotherapy for Central Airway Obstruction in Adults: An 11-Years’ Experience of a Single Center

• Jeong JH
• Kim J
• Choi CM
• Ji W

• KMID: 2545196
• DOI: http://doi.org/10.3346/jkms.2023.38.e244

Abstract

Background
Although bronchoscopic cryotherapy (BC) is a pragmatic modality for recanalization of central airway obstruction (CAO), the risk of complications, such as bleeding, remains a concern. This study aimed to present the clinical outcomes of BC and evaluate the factors associated with its complications.
Methods
In this retrospective study, we reviewed the medical records of patients who underwent BC for CAO at the Asan Medical Center, South Korea. Most sessions were conducted via flexible bronchoscopy under moderate sedation. A multivariate logistic regression analysis was used to identify the factors associated with the success rate and complications.
Results
BC was performed in 262 sessions in 208 patients between January 2009 and December 2020. The most common cause of cryotherapy was recanalization of the endobronchial tumor related CAO (233/262, 88.9%). More than partial re-establishment of airway patency was achieved in 211 of 233 (90.6%) sessions. The success rate did not differ significantly in the multivariate logistic regression analysis. The most common complication was intrabronchial bleeding (78/233, 35.5%); however, severe bleeding occurred only in one case (0.4%). Univariate and multivariate logistic regression analyses revealed that diabetes mellitus (odds ratio [OR] = 2.820, P = 0.011), respiratory failure before BC (OR = 3.546, P = 0.028), and presence of distal airway atelectasis (OR = 0.417, P = 0.021) were independently associated with moderate to severe intrabronchial bleeding, while the histologic type of tumor was not related to bleeding. BC for CAO caused by blood clot or foreign body was successful in most cases, and there were no complications.
Conclusion
BC is an efficient and relatively safe intervention for patients with CAO. Our findings suggest that diabetes, respiratory failure before BC, and the absence of distal airway atelectasis may be risk factors of moderate to severe intrabronchial bleeding.

Keyword

Cryotherapy; Recanalization; Central Airway Obstruction; Complication

Figure

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  Fig. 1 Cryotherapy for endobronchial metastasis of renal cell carcinoma. (A) Huge exophytic tumor mass in left upper lobe bronchus (white arrow). (B) Freezing and extracting the tumor mass with cryoprobe. (C) Left upper lobe bronchus after cryotherapy. (D) Extracted tumor mass.

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  Fig. 2 Flow diagram of bronchoscopic cryotherapy sessions.

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  Fig. 3 The Kaplan–Meier survival curve showing the survival patterns after intervention in patients with lung cancer, extrathoracic malignancies, and benign lesions.aThe initial number of patients was based on what is presented in Table 4. Six patients who could not be categorized were excluded.

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