[The role of endoscopic surgery in respiratory tract neoplasia]. / Il ruolo della chirurgia endoscopica nelle neoplasie dell'apparato respiratorio.

Laser therapy--either by contact or non-contact method--can be considered the best palliative option for patients affected by airway obstruction due to malignant tumors considered inoperable and/or in emergency because of inadequate ventilation. The Nd-YAG laser is widely used in endoscopy. From 1988 to September 2002 at the Department of Surgery "P Valdoni" of the University of Rome "La Sapienza" 251 clinical cases affected by airway obstruction caused by primary or metastatic malignant tumors are treated; moreover 76 stents were used. The symptomatological improvement and beneficial changes in functional breathing tests, haemogasanalysis and X-ray findings were registered 48-72 hours after each treatment. The results showed an improvement in functional breathing values especially after treatment of the main airways such as trachea and main bronchi. The therapy offered an acceptable quality of life. A fairly good number of patients may also return to radio and/or chemotherapy (if previously interrupted) and sometimes to radical surgery. In terms of costs-effectiveness, the endoscopic treatment is widely competitive.

[Use of endoprosthesis in the treatment of airway pathology]. / L'impiego di endoprotesi nel trattamento delle patologie delle vie aeree.

In patients affected by benign or malignant inoperable airway obstructions, therapeutical options include endoscopic treatment by Nd-YAG laser therapy, tracheobronchial dilatations with rigid or flexible bronchoscope, and inflating balloon dilators. Metal self-expanding or silicone stents allow to obtain stable results. Our experience is based on the use of 14 stents (10 Dumon and 4 Wallstent) in 13 cases of stenosis either due to vegetating malignant tumours not amenable to surgery or benign stenosis. In the following 24-48 hours both subjective and objective changes of the pulmonary function, blood gas analysis and radiologic aspects were observed. The results showed an improvement in the respiratory parameters and a sensible improvement in the quality of life.