title: Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer.
abstract: BACKGROUND
  Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer.
  
  
  METHODS
  In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment.
  
  
  RESULTS
  There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001).
  
  
  CONCLUSIONS
  Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD.
authors.affiliation: Department for Interventional Pulmonology, Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Put Doktora, Goldmana 4, Sremska Kamenica, Serbia.
authors.forename: Branislav
authors.initials: B
authors.lastname: Perin
authors.forename: Bojan
authors.initials: B
authors.lastname: Zaric
authors.forename: Svetlana
authors.initials: S
authors.lastname: Jovanovic
authors.forename: Jovan
authors.initials: J
authors.lastname: Matijasevic
authors.forename: Jelena
authors.initials: J
authors.lastname: Stanic
authors.forename: Ivan
authors.initials: I
authors.lastname: Kopitovic
authors.forename: Biljana
authors.initials: B
authors.lastname: Zvezdin
authors.forename: Milan
authors.initials: M
authors.lastname: Antonic