[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.

Morphologic grading of emphysema is useful in the selection of candidates for unilateral or bilateral reduction pneumoplasty.

OBJECTIVE: Radiologic morphology of emphysema proves useful in the selection of candidates for bilateral reduction pneumoplasty. We developed a simple morphologic grading system capable of identifying subsets of patients who had maximal functional improvement after unilateral or bilateral operation. METHODS: Fifty-two patients who underwent unilateral (n=34) or bilateral (n=18) reduction pneumoplasty were evaluated. Emphysema morphology was visually scored by digital roentgenograms and high-resolution computed tomography. In each lung, severity of emphysema (ES), heterogeneity (DHT) and hyperinflation (DHF) degrees, were assessed. Asymmetric ratio of emphysema (ARE) between the lungs was expressed as: higher ES/lower ES scores. Morphometric data were correlated with absolute preoperative-postoperative FEV(1) change (DeltaFEV(1)). RESULTS: No difference was found between the unilateral and the bilateral group for ES and DHT. DHF was greater in the bilateral group (3.1 vs. 2.7, P=0.02) whereas ARE was greater in the unilateral group (1.29 vs. 1. 05, P=0.0001). Stepwise logistic regression extracted as best predictors of maximal DeltaFEV(1), ARE (odds ratio=238, Wald test P=0.04) in the unilateral group, and DHT (odds ratio=24, P=0.03) in the bilateral group. Unilateral group DeltaFEV(1) was greater in patients with ARE>/=1.3 (0.44 vs. 0.24 l, P=0.02). Bilateral group DeltaFEV(1) was greater in patients with DHT>1 (0.50 vs. 0.31 l, P=0. 03). No difference was found when comparing DeltaFEV(1) resulting from unilateral RP and ARE>/=1.3, and bilateral RP (0.44 vs. 0.41 l, not significant). CONCLUSIONS: This morphologic grading system identified subsets of patients who had maximal functional benefit from unilateral or bilateral reduction pneumoplasty and might be useful in the preoperative screening of candidates for either approach.

[Treatment via laser of airway obstructions]. / Il trattamento mediante laser delle ostruzioni delle vie aeree.

The Nd-YAG laser is widely used in endoscopy. Laser therapy either by contact or non-contact method, can be considered the best palliative option for patients affected by airway obstruction due to endoluminal malignant tumours. It aims at the improvement of breathing conditions and symptomatology. In patients affected by benign obstructions, it often allows to obtain curative results avoiding the use of traditional surgery. From 1988 to 1993 at the First Department of Surgery of the University of Rome "La Sapienza", 163 treatments out of 111 clinical cases affected by airway obstruction, caused by malignant tumours considered inoperable or relapsed after operation, or by vegetating benign tumours, or granulomas or fibrous diaphragms were performed. The symptomatological improvement and beneficial changes in functional breathing tests, haemogasanalysis, and X-ray findings were registered 24-48 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 chemotherapy, if previously interrupted.