Ablative Procedures and Additional Anticancer Therapy Prolong the Survival in Patients With Endoluminal or Mixed-type Malignant Central Airway Obstruction: A Single-institution Retrospective Study

BackgroundIn patients with malignant central airway obstruction (MCAO) receiving transbronchial interventions (TBIs), it remains unclear if the prognosis after the intervention might differ according to the bronchoscopic appearance of the airway obstruction. MethodsTBIs were undertaken in MCAO patients with endoluminal obstruction (TM group, n = 19), extraluminal obstruction (EX group, n = 19) and mixed-type obstruction (MX group, n = 23), under moderate sedation and high fractions of inspired oxygen (FiO2). We evaluated the differences in the overall survival period (OS) after the TBIs among the 3 groups. ResultsRegarding the TBIs, the initial procedure was transbronchial microwave ablation (TMA) in the TM group and MX group and stent placement in the EX group. However, 7 patients in the MX group received stent placement as the second-line procedure, after failure of TMA. The OS tended to be longer in the TM/MX group as compared to that in the EX group, both in the subgroups of patients who received post-TBI anticancer therapy (27.2 months/32.9 months vs. 6.0 months, p = 0.011) and in the subgroups of patients who received best supportive care alone (3.2 months/3.1 months vs. 1.4 months, p = 0.072). Multivariate analysis identified adoption of TMA as the initial procedure, successful airway patency restoration following the TBI, and post-TBI anticancer therapy as independent factors associated with a reduced risk of death in patients with MCAO. ConclusionIt is beneficial to administer post-TBI anticancer therapy to MCAO patients with endoluminal or mixed-type obstruction following ablative procedures.

One Lung Ventilation in a Patient with Central Airway Obstruction: Fluoroscopic Guided Bronchial Blocker Placement

Thyroidectomy is the most common endocrine surgical treatment performed worldwide. Medullary thyroid carcinoma which accounts for less than 1.5 percent of these cases is different from other types of thyroid cancers in a way that it is a neuroendocrine malignancy that originates from the parafollicular C cells of the thyroid gland secreting calcitonin and it frequently spreads to lymph nodes and other organs. Anesthetic management in a case of a large thyroid mass with central airway obstruction is a task cut out for an anesthesiologist and the need to provide one-lung ventilation in these patients for thoracoscopic dissection of mediastinal lymph nodes adds to the challenges. In this case report, we describe fluoroscopic guided bronchial blocker placement as a novel technique for delivering one-lung ventilation in such patients, when the traditional approach of bronchial blocker placement with concomitant use of a fiber optic bronchoscope was not practicable due to the small size of the endotracheal tube in the presence of central airway obstruction.