title: Airway spray cryotherapy: initial outcomes from a multiinstitutional registry.
abstract: BACKGROUND
  Spray cryotherapy (SCT) uses a noncontact system to deliver liquid nitrogen (2 to 4 psi) through an endoscopic catheter. Rapid freezing and thawing of tissue causes cellular death and is also hemostatic. We report the preliminary results from 6 institutions in which SCT was used for the treatment of malignant airway tumors.
  
  
  METHODS
  SCT was performed on patients with symptomatic airway tumors and reviewed retrospectively. Airway narrowing was graded as 25% or smaller, 26% to 50%, 51% to 75%, and exceeding 75%. All events were documented and assessed.
  
  
  RESULTS
  Eighty patients (45 male [56%]) underwent 114 treatments. Median age was 66 years (range, 15 to 90 years). All patients were treated with minimal blood loss. Fifty-eight percent of the cases were outpatient procedures. Airway obstruction exceeded 75% in most of the lesions treated. There were 21 intraoperative events (19%), including hypotension, bradycardia and tachycardia, ST segment changes, desaturation, and an airway tear. Three pneumothoraces occurred, one requiring emergency chest tube placement. Two intraoperative deaths were associated with bradycardia. Three postoperative deaths occurred in patients who were transitioned to comfort care. All but 1 patient had airway patency after treatment.
  
  
  CONCLUSIONS
  SCT can be used in patients with highly vascular tumors, with reduced bleeding complications and a low overall complication rate. Caution is needed before SCT is used on a widespread basis, given the intraoperative complications. Although the potential benefit of SCT is considerable, this needs to be confirmed in larger studies.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. finleyd1@mskcc.org
authors.forename: David J
authors.initials: DJ
authors.lastname: Finley
authors.forename: Joe
authors.initials: J
authors.lastname: Dycoco
authors.forename: Saiyad
authors.initials: S
authors.lastname: Sarkar
authors.forename: William S
authors.initials: WS
authors.lastname: Krimsky
authors.forename: John T
authors.initials: JT
authors.lastname: Sherwood
authors.forename: Dominic
authors.initials: D
authors.lastname: Dekeratry
authors.forename: Gordon
authors.initials: G
authors.lastname: Downie
authors.forename: Joel
authors.initials: J
authors.lastname: Atwood
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome