Eastern Cardiothoracic Surgical Society

The Application of Spray Cryotherapy in Treatment of Benign and Malignant Bronchial Strictures
Abbas Abbas, MD, Kelly Janke, MD, Vishnu Ambur, MD,  Temple University Hospital, Philadelphia, PA

OBJECTIVE: Bronchial Spray cryotherapy (SCT), the application of liquid nitrogen by bronchoscopy, has been shown to cause cellular destruction with relative sparing of extracellular matrix. The purpose of this study is to examine the outcomes of SCT when used as an adjunct to achieve patency in benign and malignant airway stenosis.

METHODS: All patients who underwent SCT to re-establish airway patency in our institution from June 1, 2013 to May 1, 2014 were reviewed. Data was collected on patient demographics, comorbid conditions, preoperative symptoms, operative characteristics, complications, and follow up. Airway narrowing was graded as Follows: I= <25%, II=26-50%, III=51-75%, IV =76. Patency was based on initial and follow up endoscopic bronchial evaluation. Patients were also classified into 2 groups according to benign or malignant etiology of stenosis. Comparison of the initial and final grade of stenosis was performed in all patients in addition to comparing the 2 groups regarding outcomes.

RESULTS:Twenty two patients, median age 61.5 (28-75), with 28 stenotic lesions underwent a total of 66 bronchscopic procedures. Twelve patients (54.5%) had malignant strictures and 10 patients (45.5%) had benign strictures. Causes of stenosis included lung cancer in 11 patients, post-transplant anastomotic stricture in 9 patients, esophageal cancer (1) and post-intubation stricture (1). Mean ASA score was 3.5. Adjunctive endoscopic treatment included debridement, balloon dilation, and bronchial stent. Mean improvement in grade of stenosis for entire group was 2.27 (range 0-3); 2.16 in malignant strictures and 2.4 in benign strictures. The average number of SCT applications required for benign disease was 4.1 and for malignant disease was 2.0 (p=0.001). Mean follow up was 94 days (3-296). There were no intraoperative deaths while 30 day mortality was 22.7% (6), all related to metastatic disease. The complication rate was 13.8% (9) including reintubation (3), hypoxia (2), pneumothorax (1), pneumomediastinum (1), hypotension (1).

CONCLUSIONS: This study suggests that SCT, as an adjunct to bronchoscopic treatment, is a safe and effective modality for both benign and malignant strictures of the airway. Fewer treatments are required for malignant strictures while the final degree of patency is better for benign strictures.

Malignant Benign p
Number of patients 12 10
Mean number of treatments 2.0 4.1 0.001
Mean initial grade of stenosis 4.0 3.7 0.47
Mean final grade of stenosis 1.83 1.3 0.02
Mean change in grade of stenosis 2.17 2.4 0.45
Mortality (30 days) 5 1 0.16