LASER

LASER

Nd:YAG laser bronchoscopy. A five-year experience with 1,396 applications in 1,000 patients

https://pubmed.ncbi.nlm.nih.gov/3383627/

YAG Laser Therapy in Lung Cancer: An 11-Year Experience with 2,253 Applications in 1,585 Patients

https://journals.lww.com/bronchology/Abstract/1994/04000/Nd__YAG_Laser_Therapy_in_Lung_Cancer__An_11_Year.6.aspx

Landmark Article 

Reference: 

  • Cavaliere S, Foccoli P, Farina PL. Nd:YAG laser bronchoscopy. A five-year experience with 1,396 applications in 1,000 patients. Chest. 1988;94(1):15-21.
  • Cavaliere S, Foccoli P, Toninelli C, et al. Nd-YAG laser therapy in lung cancer: An 11-year experience with 2253 applications in 1585 patients. J Bronchol 1994;1:105-11.

Background: Large retrospective studies by the same authors describing the use of Nd-YAG laser in bronchoscopy.

PICO:

Populations:

  • Benign and malignant endobronchial tumor, stenosis or disease

Intervention:

  • Use of Nd-YAG laser for establishing luminal patency

Comparison:

  • None

Outcome:

  • Nd-YAG laser use was able to establish airway endoluminal patency in 93% of the cases with both a rigid and flexible bronchoscope (8% cases) with no significant morbidity or mortality profile (0.4%).

Take Home: Nd-YAG as a thermal modality was effective for endoluminal use in both malignant and benign lesions of the airway with a good safety profile.


 Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study

https://www.ncbi.nlm.nih.gov/pubmed/10531180

Landmark Article 

Reference: Boxem Tv, Muller M, Venmans B, Postmus P, Sutedja T. Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study. Chest. 1999;116(4):1108-12.

Background: Small retrospective study comparing electrocautery (EC) with Nd-YAG for therapeutic intervention in patients with NSCLC causing CAO. A cost analysis comparison between the modalities was performed.

PICO:

Populations:

  • 32 patients with NSCLC getting Nd-YAG or EC intervention for CAO

Intervention:

  • Use of Nd-YAG laser or EC for establishing endoluminal patency

Comparison:

  • Nd-YAG versus EC in CAO

Outcome:

  • 70% treatment effectiveness overall. Median survival was slightly longer in EC cases (11.5 months) than with Nd-YAG (8 months). Cost of operation was slightly more with Nd-YAG with slightly longer duration of stay compared to the EC. The number of repeat treatments was comparable.

Take Home: Bronchoscopic EC is equally effective, but is less expensive than the Nd-YAG laser for symptomatic palliation of patients with intraluminal airway obstruction.


 Endoscopic treatment of bronchial carcinoids in comparison to surgical resection: a retrospective study

https://www.ncbi.nlm.nih.gov/pubmed/23207260

Clinical Trial 

Reference: Neyman K, Sundset A, Naalsund A, et al. Endoscopic treatment of bronchial carcinoids in comparison to surgical resection: a retrospective study. J Bronchology Interv Pulmonol. 2012;19(1):29-34.

Background: Small retrospective study looking at the use of Nd-YAG laser for endoscopic resection of carcinoids. They detail their follow up cure rate and recurrence rate subsequently needing surgery.

PICO:

Populations:

  • 25 patients with carcinoids getting Nd-YAG compared to 48 patients who underwent surgical resection

Intervention:

  • Use of Nd-YAG laser for endobronchial carcinoids

Comparison:

  • Surgical intervention for carcinoids

Outcome:

  • Endoscopic Nd-YAG and surgical intervention groups had comparable results for survival rate (94.5%). Of the endoscopically treated carcinoids, about 36% needed subsequent surgical intervention

Take Home: Bronchoscopic treatment of carcinoids with Nd-YAG laser is a reasonable non-surgical choice for patients, with a comparable cure rate to surgical interventions. However, this is a small retrospective study.