Feasibility and safety of a novel electrosurgery device as part of multi-modal bronchoscopic therapy for malignant central airway lesions

摘要

Bronchoscopic interventions for restoring airway patency in patients with malignant central airway obstruction (CAO) have been proven to improve quality of life and lung function. Observational studies also suggest improvement in survival and successful weaning off mechanical ventilation in patients with CAO and respiratory failure (1-4). Patients with tracheal and mainstem bronchial obstruction and those with a high baseline dyspnea score are likely to have the greatest benefit from therapeutic bronchoscopic procedures (5). Studies show that survival in patients with malignant CAO that undergo successful recanalization is similar to those patients without CAO despite greater morbidity and lesser use of chemotherapy (6). Thermal ablative modalities consisting of contact electrosurgery (ES), argon plasma coagulation (APC) and laser-assisted debulking are the most commonly used modalities for immediate relief of airway obstruction. In contact ES, due to a voltage difference between the delivering probe and the target tissue, the electrons flow through the body and return to the grounding plate. Tissue resistance to flow generates heat that results in different effects depending on the temperature: coagulation (>60–80 °C), desiccation (>100 °C), carbonization (>200 °C) and vaporization (>300 °C) (7-10). CoreCath 2.7S (Medtronic Advanced Energy LLC, Portsmouth, NH, USA) is a relatively new FDA-approved, commercially available, single-use contact ES catheter specifically designed for airway use which enables coagulation and cut functions with an integrated suction port to evacuate carbonized tissue and smoke (11). This instrument can be used through the 2.8-mm working channel of a bronchoscope or inserted through the rigid bronchoscope. The aim of this study is to report the feasibility, safety and short-term outcomes of applying this technology in patients who undergo interventional bronchoscopic procedures for malignant CAO.