The first experience of tracheal recanalization by tumor resection with Nd-YAG-laser

Abstract

Actuality. Tracheal cancer is a rare disease which amounts up to 0.2% of the total number of cancers. Currently, there is an increase in the number of patients with impaired tracheal patency. Endoscopic procedures are most commonly used to restore and maintain the tracheal lumen. The key treatment for primary cancer is a surgical one; however, due to late diagnostics, the tumor is often inoperable. Chemotherapy for tracheal cancer is ineffective, and practically is not used. At present, endoscopic tracheal recanalization with laser vaporization is a method of choice in patients with inoperable tracheal tumors.

Objective: to improve outcomes in patients with inoperable primary tracheal cancer using Nd-YAG laser either as the fi rst component of staged treatment strategy, or as the fi nal volume treatment.

Methods. Patient K., 75 years old, was admitted to the hospital with complaints of dyspnea at rest, weakness and hemoptysis. As anamnesis showed, the patient had noticed a deterioration in her breathing during the last 6 months. CT scan revealed a volumetric formation (tumor) of the cervicothoracic trachea (8.0 cm above the bifurcation) with 90% stenosing in the lumen. When performing tracheobronchoscopy in the cervicothoracic trachea, a broad-based lumpy tumor, 5 cm long, stenosing the tracheal lumen by 2/3 was found on the posterior wall. Morphological examination of biopsy material revealed adenocystic carcinoma.

Results. The performed endoscopic examination with neodymium YAG laser recanalization demonstrated the advantage of this technique in patients with inoperable tracheal tumors.

Conclusion. Endoscopic recanalization of the trachea with neodymium YAG laser has been proven to be effective in patients with inoperable tracheal cancer. It improves their quality of life as well.