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Rigid Bronchoscopic Management of Inoperable Adenoid Cystic Carcinoma of Tracheobronchial Tree
Procedures SESSION TITLE: Procedures 1 - EMN/BT/Rigid/Cryo SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
Rigid Bronchoscopic Management of Inoperable Adenoid Cystic Carcinoma of Tracheobronchial Tree Arjun Srinivasan DM* Pattabhi Raman Vallandramam MD; and Mahadevan Sivaramakrishnan MD KMCH, Coimbatore, India PURPOSE: To evaluate the efficacy of rigid bronchoscopy in management of inoperable tracheobronchial adenoid cystic carcinoma (ACC), which is a rare slow growing tumor of salivary gland origin. METHODS: Retrospective analysis of records of patients undergoing rigid bronchoscopy for ACC in a tertiary care referral hospital between January 2011 and December 2015. RESULTS: 21 procedures were done in 11 patients (mean 1.9, range 1-6). There were 6 male (54.5 %) and 5 female (45.5%) patients with a mean age of 55.5 years. Presenting complaint was respiratory failure in 10 (90.9%) and post obstructive pneumonia (POS) in 1 patient (9.1%). Involvement was predominantly endobronchial in 3 (27.3%), endobronchial with extrinsic component in 6(54.5%) and diffuse infiltrative in 2 patients (18.2%). Site of obstruction was tracheal in 4 (36.4%), carinal in 6 (54.5%) and left main bronchial in 1 patient (9.1%). 3 patients had been treated in the past (2 surgical resection and 1 radiotherapy). Tumor debulking alone was done in 16 (76.2%) and stent was also placed during 5 (24.8%) procedures. Minor complications were encountered in 2 patients (subcutaneous emphysema in 1 patient, stent migration in 1 patient). One patient who had undergone pneumonectomy earlier with stump recurrence died due to massive bleed during bronchoscopic procedure(mortality 9.1%). 8 of the remaining patients (80%) are symptom free after a mean follow up of 25.9 months, 2 patients (20%) died after 14 and 36 months due to ventricular tachycardia and SVC syndrome respectively. CONCLUSIONS: Rigid bronchoscopic management provides swift relief of symptoms in patients of ACC who are inoperable. Patients often require more than one session and need to be on regular surveillance to detect recurrence. Bleeding is rare but can be massive. CLINICAL IMPLICATIONS: Bronchoscopic palliation in inoperable tracheobronchial effective with significant long-term survival and should therefore be considered in all symptomatic patients.
No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.1115
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
1009A
PROCEDURES
DISCLOSURE: The following authors have nothing to disclose: Arjun Srinivasan, Pattabhi Raman Vallandramam, Mahadevan Sivaramakrishnan
Rigid Bronchoscopic Management of Inoperable Adenoid Cystic Carcinoma of Tracheobronchial Tree Arjun Srinivasan DM* Pattabhi Raman Vallandramam MD; and Mahadevan Sivaramakrishnan MD KMCH, Coimbatore, India PURPOSE: To evaluate the efficacy of rigid bronchoscopy in management of inoperable tracheobronchial adenoid cystic carcinoma (ACC), which is a rare slow growing tumor of salivary gland origin. METHODS: Retrospective analysis of records of patients undergoing rigid bronchoscopy for ACC in a tertiary care referral hospital between January 2011 and December 2015. RESULTS: 21 procedures were done in 11 patients (mean 1.9, range 1-6). There were 6 male (54.5 %) and 5 female (45.5%) patients with a mean age of 55.5 years. Presenting complaint was respiratory failure in 10 (90.9%) and post obstructive pneumonia (POS) in 1 patient (9.1%). Involvement was predominantly endobronchial in 3 (27.3%), endobronchial with extrinsic component in 6(54.5%) and diffuse infiltrative in 2 patients (18.2%). Site of obstruction was tracheal in 4 (36.4%), carinal in 6 (54.5%) and left main bronchial in 1 patient (9.1%). 3 patients had been treated in the past (2 surgical resection and 1 radiotherapy). Tumor debulking alone was done in 16 (76.2%) and stent was also placed during 5 (24.8%) procedures. Minor complications were encountered in 2 patients (subcutaneous emphysema in 1 patient, stent migration in 1 patient). One patient who had undergone pneumonectomy earlier with stump recurrence died due to massive bleed during bronchoscopic procedure(mortality 9.1%). 8 of the remaining patients (80%) are symptom free after a mean follow up of 25.9 months, 2 patients (20%) died after 14 and 36 months due to ventricular tachycardia and SVC syndrome respectively. CONCLUSIONS: Rigid bronchoscopic management provides swift relief of symptoms in patients of ACC who are inoperable. Patients often require more than one session and need to be on regular surveillance to detect recurrence. Bleeding is rare but can be massive. CLINICAL IMPLICATIONS: Bronchoscopic palliation in inoperable tracheobronchial effective with significant long-term survival and should therefore be considered in all symptomatic patients.
No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.1115
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
1009A
PROCEDURES
DISCLOSURE: The following authors have nothing to disclose: Arjun Srinivasan, Pattabhi Raman Vallandramam, Mahadevan Sivaramakrishnan