Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer

Branislav Perin; Bojan Zaric; Svetlana Jovanovic; Jovan Matijasevic; Jelena Stanic; Ivan Kopitovic; Biljana Zvezdin; Milan Antonic

doi:10.4103/1817-1737.102184

Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer

Ann Thorac Med. 2012 Oct;7(4):233-7. doi: 10.4103/1817-1737.102184.

Authors

Branislav Perin¹, Bojan Zaric, Svetlana Jovanovic, Jovan Matijasevic, Jelena Stanic, Ivan Kopitovic, Biljana Zvezdin, Milan Antonic

Affiliation

¹ Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia.

Abstract

Introduction: Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer.

Methods: In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment.

Results: There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001).

Conclusion: Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD.

Keywords: Bronchoscopy; Nd:YAG laser; interventional pulmonology; laser resection; lung cancer; treatment.