In this article, we discussed a 50 year-old male patient with a recurrent endobronchial thymoma after surgical operation, who underwent endobronchial laser recanalization seven times in a three years period, and the results of laser treatment was evaluated.
Endobronchial laser therapy is usually preferably performed with rigid bronchoscope. Risk of asphyxia due to possible bleeding, secretions or smoke during the procedure should be prevented. This can be provided by continuos suction that maintains a airway patency. To prevent hemorrhage it is important to coagulate tumoral mass. Mechanical resection is applied by core out techniques. Then, base of the tumor is vaporized by laser [6]. When performed by using the appropriate technique, bronchoscopic laser therapy provides central airway patency and thus symptomatic and functional improvement. In a series including a total of 2008 cases with malignant tracheobronchial obstruction, Nd-YAG laser presented a success rate of 93% [7]. Hemorrhage was observed in 19 and pneumothorax in 8 patients, but no deaths was reported. Endoscopic laser therapies are advantageous compared to other endobronchial therapies since they are effective, easy to perform, safe and repeatable.
Bronchoscopic laser therapy induces dramatic improvement in acute respiratory insufficiency due to central airway obstruction. It also provides weaning from mechanical ventilators and decreases the cost of treatment. Laser therapy is proposed as an expensive method. But, when applied during early stages of disease, its economical availability can be enhanced. Hospital costs of emergency care units are reported as much as 3.5 times more expensive than laser therapy [8].
In this case, endobronchial laser therapy was performed six times during a three year period. The patient tolerated the method well and no complication was observed. After surgical resection respiratory insufficiency developed due to tumor recurrence. Despite serious recurrences palliative treatment provided acceptable life quality and maintained survival. In malignancies with endoluminal tracheobronchial obliteration, laser recanalization can be repeatedly performed thus localized disease could be controlled and asyphyxia could be prevented. In conclusion, this therapeutic modality prolongs survival and improves life quality in such patients.