Long-Term Outcomes of Interventional Bronchoscopy for Central Airway Obstruction in a Single-Center Retrospective Study: A Subgroup Analysis of Malignant and Benign Lesions.

Background: Central airway obstruction (CAO) remains a major challenge in thoracic oncology, particularly in patients with advanced lung cancer. Despite advances in systemic therapies, interventional bronchoscopy, especially rigid bronchoscopy (RB), plays a critical role in managing CAO.

Methods: Between June 2005 and December 2023, 416 patients with central airway obstructions were treated. The cohort included 213 males (51%) and 203 females (49%), with a mean age of 64.8 years. A retrospective review of patient data was conducted, and descriptive statistics were used to summarize demographics and procedural outcomes. Survival rates and complication data were analyzed using Kaplan-Meier survival curves. Multivariate analysis was performed to identify significant predictors of survival and complications, considering factors such as tumor stage, prior treatments, and comorbidities. The study also analyzed the impact of adjuvant therapies and stenting on patient outcomes.

Results: Of the 416 patients, 86 (20.7%) had benign lesions, including 61 cases of post-tracheostomy stenosis or prolonged intubation, while the remaining 330 (79.3%) had malignant CAO. Patients receiving adjuvant therapies showed a significant survival advantage, with a median survival of 24 months compared to 15 months for those not receiving adjuvant therapies (p = 0.015). Stenting was performed in 141 cases, but no significant survival difference was found between patients with and without stents (p = 0.52). Complications were rare, with airway rupture observed in 1.9% and perioperative mortality in 0.25%. Symptom relief was achieved in the majority of patients, with significant improvements in quality of life, particularly in those with malignant obstructions.

Conclusions: RB remains a cornerstone in the management of CAO, providing effective and durable symptom relief. It is particularly beneficial for advanced malignancies, offering a palliative approach that improves both survival and quality of life. Our study supports the guidelines endorsing RB for CAO management and highlights its role in providing significant symptom relief and stabilization in patients with severe airway obstruction.